Abstract
The cerebral hypoperfusion caused by chronic progressive stenosis or occlusion of intracranial arteries in moyamoya disease can be treated by direct bypass or indirect revascularization procedures. The extent of collaterals from the external carotid artery (ECA) after indirect revascularization surgery is the key point of angiographic follow-up, and the invasiveness of angiography impelled us to investigate the role of ultrasonography in the evaluation of collaterals. We hypothesized that the collaterals shown on angiography might produce corresponding hemodynamic changes in color Doppler ultrasonography. We prospectively recruited moyamoya patients who underwent indirect revascularization surgery and received both preoperative and postoperative angiography and color Doppler ultrasound studies. The collaterals on angiography were graded according to Matsushima method. A total of 21 patients (age, 17 ± 10.2 years) with 24 operated hemispheres were enrolled. Patients who showed better collateral establishment by angiography had higher end-diastolic velocity (EDV), lower resistance index (RI), and larger flow volume in the superficial temporal artery (STA) and ECA (all p < 0.05). In STA, increase of EDV greater than 13.5 cm/sec or reduction of RI greater than 0.19 after operation corresponded to 94% of Matsushima grade A+B. In ECA, post-operative EDV greater than 22 cm/sec or increase of EDV greater than 6.4 cm/sec also corresponded to 94% of Matsushima grade A+B. Our findings revealed potential roles of color Doppler ultrasonography in identifying patients with poor collaterals after indirect revascularization procedures.
Highlights
Moyamoya disease (MMD) is an important etiology among pediatric as well as adult stroke patients especially in Far Eastern countries [1,2,3]
This study aimed to investigate color Doppler ultrasonography as a follow-up tool by correlating the ultrasonographic parameters with angiographic Matsushima grades in moyamoya patients after indirect revascularization surgery
The post-operative Matsushima grade was A in 11 hemispheres, B in 7, and C in 6 with a follow up period of 8.5 ± 7 months
Summary
Moyamoya disease (MMD) is an important etiology among pediatric as well as adult stroke patients especially in Far Eastern countries [1,2,3]. Ischemic stroke is prevalent in both age groups of MMD, while haemorrhagic stroke is presented more frequently in adult than in pediatric moyamoya patients [2]. Ultrasonography for postoperative collaterals in MMD cerebrovascular diseases: using pediatric moyamoya disease as a pilot", as well as National Taiwan University Hospital grants (104-N2871 and MOST 104-2314-B-002-131, for Dr Shin-Joe Yeh) in paying for English editing of this manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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