Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease

Cho, H. H.; Cheon, Jung Eun; Kim, S. K.; Choi, Yong‐Kook; Kim, I. O.; Kim, W. S.; Lee, S. M.; You, Sun Kyoung; Shin, Sei One

doi:10.3174/ajnr.a4614

Cited by 13 publications

(10 citation statements)

References 30 publications

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“…Furthermore, the extent of neovascularization from the graft tissue was parallel to the changes in regional CBF [ 17 ]. Moreover, Cho et al [ 18 ] showed that the degree of neovascularization on cerebral angiographic images after indirect bypass surgeries correlated with clinical outcome. In cases of inadequate revascularization with symptoms of cerebral hypoperfusion, second salvage surgery should be considered.…”

Section: Discussionmentioning

confidence: 99%

Color Doppler ultrasonography as an alternative tool for postoperative evaluation of collaterals after indirect revascularization surgery in Moyamoya disease

et al. 2017

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The cerebral hypoperfusion caused by chronic progressive stenosis or occlusion of intracranial arteries in moyamoya disease can be treated by direct bypass or indirect revascularization procedures. The extent of collaterals from the external carotid artery (ECA) after indirect revascularization surgery is the key point of angiographic follow-up, and the invasiveness of angiography impelled us to investigate the role of ultrasonography in the evaluation of collaterals. We hypothesized that the collaterals shown on angiography might produce corresponding hemodynamic changes in color Doppler ultrasonography. We prospectively recruited moyamoya patients who underwent indirect revascularization surgery and received both preoperative and postoperative angiography and color Doppler ultrasound studies. The collaterals on angiography were graded according to Matsushima method. A total of 21 patients (age, 17 ± 10.2 years) with 24 operated hemispheres were enrolled. Patients who showed better collateral establishment by angiography had higher end-diastolic velocity (EDV), lower resistance index (RI), and larger flow volume in the superficial temporal artery (STA) and ECA (all p < 0.05). In STA, increase of EDV greater than 13.5 cm/sec or reduction of RI greater than 0.19 after operation corresponded to 94% of Matsushima grade A+B. In ECA, post-operative EDV greater than 22 cm/sec or increase of EDV greater than 6.4 cm/sec also corresponded to 94% of Matsushima grade A+B. Our findings revealed potential roles of color Doppler ultrasonography in identifying patients with poor collaterals after indirect revascularization procedures.

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Section: Discussionmentioning

confidence: 99%

Color Doppler ultrasonography as an alternative tool for postoperative evaluation of collaterals after indirect revascularization surgery in Moyamoya disease

et al. 2017

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“…The most effective treatment for MMD is extracranial-intracranial (EC-IC) revascularization surgery including direct bypass, indirect bypass, or combined bypass techniques [ 2 , 3 ]. The direct bypass or the combined bypass can improve intracranial 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 – 6 ]. Previous studies have reported that neoangiogenesis in the surgical area, reduced moyamoya vessels and improved intracranial perfusion (examined by postoperative computed tomography perfusion [CTP]), could be found during follow-up [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Quantitative Angiographic Hemodynamic Evaluation After Revascularization Surgery for Moyamoya Disease

Chen

Yang³

et al. 2020

Transl. Stroke Res.

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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.

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“…Quantitative color-coded parametric DSA (QDSA, Syngo iFlow) is an emerging DSA technique which provides objective perfusion parameters like time-to-peak (TTP), mean transit time (MTT), and ratios of area under the curve (AUC ratio) to assess hemodynamic changes of a certain artery after bypass surgery. Although it does not provide information on cerebral parenchyma perfusion, it is useful for measuring blood supply from the internal and external carotid artery systems [8,9]. However, DSA is not recommended for pediatric patients or patients in poor conditions, due to its invasiveness, time consumption, and need for anesthesia.…”

Section: Digital Subtraction Angiography (Dsa)mentioning

confidence: 99%

Imaging methods for surgical revascularization in patients with moyamoya disease: an updated review

Jiang

et al. 2021

Neurosurg Rev

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Neuroimaging is crucial in moyamoya disease (MMD) for neurosurgeons, during pre-surgical planning and intraoperative navigation not only to maximize the success rate of surgery, but also to minimize postsurgical neurological deficits in patients. This is a review of recent literatures which updates the clinical use of imaging methods in the morphological and hemodynamic assessment of surgical revascularization in patients with MMD. We aimed to assist surgeons in assessing the status of moyamoya vessels, selecting bypass arteries, and monitoring postoperative cerebral perfusion through the latest imaging technology.

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Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease

Cited by 13 publications

References 30 publications

Color Doppler ultrasonography as an alternative tool for postoperative evaluation of collaterals after indirect revascularization surgery in Moyamoya disease

Color Doppler ultrasonography as an alternative tool for postoperative evaluation of collaterals after indirect revascularization surgery in Moyamoya disease

Quantitative Angiographic Hemodynamic Evaluation After Revascularization Surgery for Moyamoya Disease

Imaging methods for surgical revascularization in patients with moyamoya disease: an updated review

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