Abstract
One feature that patients with steno-occlusive cerebrovascular disease have in common is the presence of white matter (WM) lesions on MRI. The purpose of this study was to evaluate the effect of direct surgical revascularization on impaired WM cerebrovascular reactivity in patients with steno-occlusive disease. We recruited 35 patients with steno-occlusive disease, Moyamoya disease (n = 24), Moyamoya syndrome (n = 3), atherosclerosis (n = 6), vasculitis (n = 1), and idiopathic stenosis (n = 1), who underwent unilateral brain revascularization using a direct superficial temporal artery-to-MCA bypass (19 women; mean age, 45.8 ± 16.5 years). WM cerebrovascular reactivity was measured preoperatively and postoperatively using blood oxygen level-dependent (BOLD) MR imaging during iso-oxic hypercapnic changes in end-tidal carbon dioxide and was expressed as %Δ BOLD MR signal intensity per millimeter end-tidal partial pressure of CO2. WM cerebrovascular reactivity significantly improved after direct unilateral superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass in the revascularized hemisphere in the MCA territory (mean ± SD, -0.0005 ± 0.053 to 0.053 ± 0.046 %BOLD/mm Hg; P < .0001) and in the anterior cerebral artery territory (mean, 0.0015 ± 0.059 to 0.021 ± 0.052 %BOLD/mm Hg; P = .005). There was no difference in WM cerebrovascular reactivity in the ipsilateral posterior cerebral artery territory nor in the vascular territories of the nonrevascularized hemisphere (P < .05). Cerebral revascularization surgery is an effective treatment for reversing preoperative cerebrovascular reactivity deficits in WM. In addition, direct-STA-MCA bypass may prevent recurrence of preoperative symptoms.
Highlights
BACKGROUND AND PURPOSEOne feature that patients with steno-occlusive cerebrovascular disease have in common is the presence of white matter (WM) lesions on MRI
WM cerebrovascular reactivity significantly improved after direct unilateral superficial temporal artery–to-middle cerebral artery (STA-MCA) bypass in the revascularized hemisphere in the MCA territory and in the anterior cerebral artery territory
The inclusion criteria for this study were the following: 1) patients with intracranial steno-occlusive disease who had a unilateral direct extracranial-intracranial bypass of the superficial temporal artery to MCA (STA-MCA); 2) the presence of steal physiology on the prerevascularization Cerebrovascular reactivity (CVR) map; 3) an available preoperative CVR study and at least 1 postoperative CVR study at 3 months or later postsurgery; 4) both preoperative and postoperative CVR studies performed with the same CO2 stimulus protocol and acquisition parameters; and 5) all patient CVR data being sufficiently free of artifacts to be comparable, as determined by a neuroradiologist experienced in blood oxygen level– dependent (BOLD) MR imaging CVR assessment (D.J.M.)
Summary
The purpose of this study was to evaluate the effect of direct surgical revascularization on impaired WM cerebrovascular reactivity in patients with steno-occlusive disease
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