Prediction of Cerebral Hyperperfusion after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis by Three-Dimensional-Time-of-Flight Magnetic Resonance Angiography in Adult Patients with Moyamoya Disease

Autor: Masahito Katsuki, Ryosuke Tashiro, Kenichi Sato, Miki Fujimura, Shunji Mugikura, Taketo Nishizawa, Teiji Tominaga
Rok vydání: 2020
Předmět:
Adult
Male
Middle Cerebral Artery
medicine.medical_specialty
Adolescent
Posterior cerebral artery
030204 cardiovascular system & hematology
Risk Assessment
Magnetic resonance angiography
Young Adult
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Risk Factors
medicine.artery
Internal medicine
medicine
Anterior cerebral artery
Humans
cardiovascular diseases
Moyamoya disease
Aged
Cerebral Revascularization
Revascularization surgery
medicine.diagnostic_test
business.industry
Anastomosis
Surgical
Syndrome
Middle Aged
Superficial temporal artery
medicine.disease
Cerebral Angiography
Temporal Arteries
Cerebrovascular Disorders
Treatment Outcome
Neurology
Cerebral blood flow
Cerebrovascular Circulation
Middle cerebral artery
cardiovascular system
Cardiology
Female
Neurology (clinical)
Moyamoya Disease
Cardiology and Cardiovascular Medicine
business
Magnetic Resonance Angiography
030217 neurology & neurosurgery
circulatory and respiratory physiology
Zdroj: Cerebrovascular Diseases. 49:396-403
ISSN: 1421-9786
1015-9770
DOI: 10.1159/000509740
Popis: Introduction: Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is an effective surgical procedure for adult patients with moyamoya disease (MMD) and is known to have the potential to prevent cerebral ischemia and/or hemorrhagic stroke. Cerebral hyperperfusion (CHP) syndrome is one of the serious complications of this procedure that can result in deleterious outcomes, such as delayed intracerebral hemorrhage, but the prediction of CHP before revascularization surgery remains challenging. The present study evaluated the diagnostic value of preoperative three-dimensional (3D)-time-of-flight (TOF) magnetic resonance angiography (MRA) for predicting CHP after STA-MCA anastomosis for MMD. Materials and Methods: The signal intensity of the peripheral portion of the intracranial major arteries, such as the anterior cerebral artery (ACA), MCA, and posterior cerebral artery (PCA) ipsilateral to STA-MCA anastomosis, on preoperative MRA was graded (0–2 in each vessel) according to the ability to visualize each vessel on 97 affected hemispheres in 83 adult MMD patients. Local cerebral blood flow (CBF) at the site of anastomosis was quantitatively measured by N-isopropyl-p-[123I]-iodoamphetamine single-photon emission computed tomography 1 and 7 days after surgery, in addition to the preoperative CBF value at the corresponding area. Then, we investigated the correlation between the preoperative MRA score and the development of CHP. Results: The CHP phenomenon 1 day after STA-MCA anastomosis (local CBF increase over 150% compared with the preoperative value) was evident in 27 patients (27/97 hemispheres; 28%). Among them, 8 (8 hemispheres) developed CHP syndrome. Multivariate analysis revealed that the hemispheric MRA score (0–6), the summed ACA, MCA, and PCA scores for the affected hemisphere, was significantly associated with the development of CHP syndrome (p = 0.011). The hemispheric MRA score was also significantly correlated with the CHP phenomenon, either symptomatic or asymptomatic (p < 0.001). Conclusion: The signal intensity of the intracranial major arteries, including the ACA, MCA, and PCA, on preoperative 3D-TOF MRA may identify adult MMD patients at higher risk for CHP after direct revascularization surgery.
Databáze: OpenAIRE
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