Using postoperative remodeling of donor arteries on MR angiography to predict the development of surgical collaterals in moyamoya disease
| Autor: | Haruto Uchino, Satoshi Kuroda, Shusuke Yamamoto, Daina Kashiwazaki, Naoki Akioka, Naoya Kuwayama, Kyo Noguchi |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry Middle meningeal artery medicine.medical_treatment Context (language use) General Medicine Digital subtraction angiography medicine.disease Revascularization Superficial temporal artery 03 medical and health sciences 0302 clinical medicine Bypass surgery 030220 oncology & carcinogenesis medicine.artery Internal medicine Deep temporal arteries Cardiology Medicine Moyamoya disease business 030217 neurology & neurosurgery |
| Zdroj: | Journal of neurosurgery. |
| ISSN: | 1933-0693 |
| Popis: | OBJECTIVEThe calibers of donor arteries can change dynamically after bypass surgery in patients with moyamoya disease (MMD). The present study aimed to evaluate the cutoffs of caliber changes in donor arteries associated with good surgical revascularization and to assess the impact of clinical factors potentially related to bypass development.METHODSThe authors studied 71 hemispheres of 30 adults and 16 children with MMD who underwent combined direct and indirect revascularization. They quantitatively measured the calibers of the superficial temporal artery (STA), deep temporal artery (DTA), and middle meningeal artery (MMA) with MR angiography (MRA) source images and calculated the postoperative caliber change ratios (CCRs) to assess direct and indirect bypass development. These values were compared with the findings of digital subtraction angiography, in which revascularization areas were categorized into 3 groups (poor, good, and excellent).RESULTSIn both adult and pediatric hemispheres, the median STA and DTA CCRs were higher in better-revascularization groups (p < 0.05), while MMA CCRs were not significantly different among the groups. Receiver operating characteristic analysis revealed that the cutoff STA CCRs of > 1.1 and > 1.3 were associated with good direct revascularization in adult and pediatric hemispheres, respectively. Cutoff DTA CCRs of > 1.6 and > 1.2 were associated with good indirect revascularization in adult and pediatric hemispheres, respectively. Considering these cutoff values, STA and DTA CCRs showed high median values, irrespective of age, severity of cerebrovascular reserve, disease stage, and disease-onset type.CONCLUSIONSCaliber changes in STAs and DTAs can be easily measured using MRA, and they could be indicators of direct and indirect bypass development. The dual development of a direct and indirect bypass was most frequently observed in the context of a combined bypass procedure in both adults and children with MMD. |
| Databáze: | OpenAIRE |
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