Quantitative Angiographic Hemodynamic Evaluation After Revascularization Surgery for Moyamoya Disease

Yu Chen,Yuanli Zhao,Jan-Karl Burkhardt,Junlin Lu,Li Ma,Rong Wang,Weijian Jiang,Xiaolin Chen,Xun Ye,Shuo Yang,Zeguang Ren

doi:10.1007/s12975-020-00781-5

Abstract

The corresponding hemodynamic changes of the internal carotid artery (ICA) after the revascularization surgery for moyamoya disease (MMD) remain unclear. The aim of this study was to analyze the hemodynamic changes of the ipsilateral ICA after the combined direct and indirect extracranial-intracranial (EC-IC) bypass. MMD patients undergoing combined EC-IC bypass were retrospectively reviewed. The mean transit time (MTT) of ICA was evaluated by color-coding angiography before revascularization and at follow-up. The MTT defined as the blood transit time between the end of cervical portion (C1) and the C7 segment of ICA. The clinical prognosis was assessed with Matsushima grading system, moyamoya vessel reduction system, and modified Rankin Scale (mRS). The correlation between hemodynamic parameter and prognosis was analyzed. Subgroup analysis was conducted between different presentations and different ages. Fifty-one patients were identified and the mean imaging follow-up interval was 5.5 months. The ICA-MTT was increased after the combined revascularization (P < 0.001) compared with contralateral ICA. Faster preoperative ICA-MTT was significantly associated with improved mRS in the ischemic group (P = 0.05). The increased ICA-MTT was significantly associated with favorable neoangiogenesis (P = 0.04), moyamoya vessel reduction (> 50%) (P = 0.023), and improved mRS score (P = 0.008). In subgroup analysis, the correlation in the ischemic subgroup and adult subgroup remained significant. In this cohort, the ICA-MTT increased after the combined EC-IC bypass, and there was a positive correlation between the increased blood transit time and favorable outcomes. Color-coding DSA proved to be useful as a quantitative and serial method to monitor postoperative courses after revascularization in MMD.

Highlights

Moyamoya disease (MMD) is characterized by chronic, progressive stenosis, or occlusion of unknown causes that occurred in the distal internal carotid artery (ICA) and its branches, along with development of collateral vessels at the base of the brain [1]
We further investigate the correlation between ICA-mean transit time (MTT) changes and angiographic or clinical improvement, and subgroup analysis was carried out to clarify whether the correlation still exists in hemorrhagic and ischemic-onset MMD
We focus on postoperative hemodynamic changes of ICA in MMD patients

Summary

Introduction

Moyamoya disease (MMD) is characterized by chronic, progressive stenosis, or occlusion of unknown causes that occurred in the distal internal carotid artery (ICA) and its branches, along with development of collateral vessels at the base of the brain [1]. The most effective treatment for MMD is extracranial-intracranial (ECIC) revascularization surgery including direct bypass, indirect bypass, or combined bypass techniques [2, 3]. (2020) 11:871–881 perfusion by instantly increasing cerebral blood flow while later de novo collateral vessels will form from the indirect/extracranial graft, and it is increasingly considered more effective than only indirect treatment strategies for MMD patients [4,5,6]. Reports on hemodynamic changes of ICA after revascularization are still scant [8]. Though most of the ICA is located outside the skull, its hemodynamic changes may indirectly reflect the intracranial external carotidinternal carotid conversion and clinical prognosis

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