Evaluation of Hemodynamics Before and After Revascularization in Hemorrhagic Moyamoya Disease: A Computed Tomography Perfusion Imaging Case Study

Wang, Xiaoqiang; Chong, Zhen; Guo, Xiang; Liu, Deguo; Sun, Zhanguo; Chen, Yueqin; Gao, Lingyun

doi:10.1016/j.wneu.2019.07.135

Cited by 4 publications

(6 citation statements)

References 20 publications

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“…From this, it could be inferred that neurologic deficits are more likely to occur as the local hemodynamic change becomes larger. The evaluation of hemodynamic changes in MMD from previous studies [11][12][13] has mainly focused on the hemisphere and regional cerebral perfusion changes by means of CT perfusion and multimodal MRI. These kinds of evaluations can assess the change of blood flow quantitively and predict the occurrence of HPS.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Hemodynamic Change by Indocyanine Green-FLOW 800 Videoangiography Mapping: Prediction of Hyperperfusion Syndrome in Patients with Moyamoya Disease

Zhang

Feng

et al. 2020

Oxidative Medicine and Cellular Longevity

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Objective. Hyperperfusion syndrome (HPS) after bypass surgery for moyamoya disease (MMD) mainly results from redistribution of blood flow, which leads to poor outcomes, while effective methods to predict HPS are still lacking. Indocyanine green (ICG) videoangiography can assess regional cerebral blood flow changes semiquantitatively with the application of FLOW 800 software. The purpose of this study was to investigate whether the intraoperative evaluation of local hemodynamic changes around anastomotic sites using FLOW 800 videoangiography mapping can predict the incidence of HPS and clinical outcomes. Methods. Of the patients who were diagnosed with MMD in our hospital between August 2018 and December 2019, who underwent superficial temporal artery-middle cerebral artery bypass surgeries, we investigated 65 hemispheres (in 62 patients) in which intraoperative ICG analysis was performed using FLOW 800 (Zeiss Meditec, Oberkochen, Germany) to evaluate the local cerebral hemodynamics before and after anastomosis. Regions of interest were set at more than 2 points on the brain surface according to the location and situation of recipient arteries in the surgical area. Peak cerebral blood volume (CBV), regional cerebral blood flow (CBF), and time to peak (TTP) were calculated from the selected points. As the data were available intraoperatively, anastomoses were performed in a suitable area. According to the occurrence of HPS, patients were divided into the asymptomatic and symptomatic groups, from which hemodynamic parameters were compared. Furthermore, ROC analysis was performed to determine the diagnostic accuracy of change rates in CBV, CBF, and TTP (i.e., ΔCBV, ΔCBF, and ΔTTP) for predicting HPS. Results. Data from the 62 patients were analyzed, and all patients were closely assessed during hospitalization after the procedures. The values of ΔCBV and ΔCBF were significantly higher in the symptomatic group (p<0.01), while ΔTTP is slightly lower in the symptomatic group with no statistical differences (p=0.72). Hemodynamic parameters including ΔCBV and ΔCBF, calculated by FLOW 800, had high sensitivity and specificity according to the ROC curve (ΔCBV: AUC=0.743, 95% CI, 0.605–0.881, p=0.002; ΔCBF: AUC=0.852, 95% CI, 0.750–0.954, p<0.01), which could be used as predictors for HPS. Conclusions. Intraoperative ICG-FLOW 800 videoangiography mapping is a safe method which can reflect hemodynamic characteristics in the surgical area for MMD, the findings of which correlate with the occurrence of HPS. Parameters including ΔCBV and ΔCBF are proven to be efficient in the prediction of HPS.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Hemodynamic Change by Indocyanine Green-FLOW 800 Videoangiography Mapping: Prediction of Hyperperfusion Syndrome in Patients with Moyamoya Disease

Zhang

Feng

et al. 2020

Oxidative Medicine and Cellular Longevity

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“…CTP, a noninvasive method for examining cerebral blood perfusion, has been shown to effectively evaluate cerebral hemodynamics in patients with cerebrovascular diseases (4,30,31). Notably, age, sex, and clinical types were found to be potential risk factors for cerebral perfusion changes in adult patients with MMD.…”

Section: It Has Been Established That Chs Occurs Only Aftermentioning

confidence: 99%

“…Notably, disease progression is associated with the development of ischemic or hemorrhagic stroke, which are leading causes of death and severe disability (2). Ischemic MMD occurs mostly in children, while hemorrhagic MMD occurs more often in adults, which affected approximately 20% of adult MMD patients (3,4). Thus far, no specific treatment therapy for the prevention or reversal of MMD has been developed, although surgery is widely used to primarily improve cerebral blood flow with hypoperfusion (5).…”

Section: Introductionmentioning

confidence: 99%

“…Various types of perfusion imaging have become critical for evaluating cerebral hemodynamic changes and the reserve of the cerebrovascular system prior to and following revascularization. Particularly, perfusion imaging can be used to evaluate the therapeutic effect of revascularization based on quantitative indexes of cerebral hemodynamics (4). Computed tomography perfusion (CTP) is a rapid and noninvasive imaging technique that enables the quantification of perfusion parameters (4).…”

Section: Introductionmentioning

confidence: 99%

“…Particularly, perfusion imaging can be used to evaluate the therapeutic effect of revascularization based on quantitative indexes of cerebral hemodynamics (4). Computed tomography perfusion (CTP) is a rapid and noninvasive imaging technique that enables the quantification of perfusion parameters (4). However, to date, only a handful of studies have described the risk factors of hemodynamics (7,8).…”

Section: Introductionmentioning

confidence: 99%

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Diabetes or calcium channel blocker contribute to cerebral hemodynamics after bypass surgery in adult patients with moyamoya disease

Han¹,

Cai²,

Wei³

et al. 2023

Quant Imaging Med Surg

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Background: Moyamoya disease (MMD) is a teratogenic and lethal disease. However, existing studies do not sufficiently indicate the impact factors. Therefore, we investigated the different impact factors on cerebral hemodynamics after revascularization in patients with MMD. Methods:We retrospectively collected the clinical data of 233 adult patients with MMD who underwent revascularization surgery in the Department of Neurosurgery, Renmin Hospital of Wuhan University, from January 2015 to June 2021 for this retrospective cohort study. We analyzed the effects on hemodynamic improvement of age, sex, stroke type, early symptoms, Suzuki stage, history of hypertension, history of diabetes, and history of hyperlipidemia in patients with MMD. We also evaluated the efficacy of different revascularization strategies and we verified the effect of computed tomography perfusion (CTP) in evaluating cerebral hemodynamics. Results:The CTP values demonstrated that δ cerebral blood volume (CBV) values were significantly higher in the combined group [1.01 (0.87-1.75)] relative to those in the indirect group [1.34 (1.01-1.63); P=0.027]. There was no statistical significance in the improvement of clinical symptoms and clinical prognosis between the indirect and combined groups. Patients with MMD with diabetes [δ mean transit time (MTT), 0.49 (0.35-0.70) vs. 0.72 (0.52-0.87); P<0.001] or calcium channel blocker (CCB) [δCBV, 1.46 (1.10-1.83) vs. 1.12 (0.93-1.54); P=0.001] had better cerebral hemodynamics than patients in non-diabetic group or non-CCB group after revascularization. Conclusions:We didn't find differences in clinical outcome between indirect and combined revascularization in patients with MMD. we demonstrated that CTP values can be used as a way to detect postoperative cerebral hemodynamic changes in MMD patients. Interestingly, we found that MMD patients with diabetes or CCB showed better cerebral perfusion after revascularization.

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Longitudinal evaluation of cerebral perfusion evolution after revascularization surgery in moyamoya disease by CT perfusion

Yingqian,

Dan,

Liping

et al. 2024

Journal of Stroke and Cerebrovascular Diseases

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Evaluation of Hemodynamics Before and After Revascularization in Hemorrhagic Moyamoya Disease: A Computed Tomography Perfusion Imaging Case Study

Cited by 4 publications

References 20 publications

Evaluation of Hemodynamic Change by Indocyanine Green-FLOW 800 Videoangiography Mapping: Prediction of Hyperperfusion Syndrome in Patients with Moyamoya Disease

Evaluation of Hemodynamic Change by Indocyanine Green-FLOW 800 Videoangiography Mapping: Prediction of Hyperperfusion Syndrome in Patients with Moyamoya Disease

Diabetes or calcium channel blocker contribute to cerebral hemodynamics after bypass surgery in adult patients with moyamoya disease

Longitudinal evaluation of cerebral perfusion evolution after revascularization surgery in moyamoya disease by CT perfusion

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