Postoperative vascular event prediction using angiography and ultrasonography in patients with Moyamoya disease

Shin-Joe Yeh; Sung-Chun Tang; Li-Kai Tsai; Tzu-Ching Chen; Pei-Lin Li; Ya-Fang Chen; Meng-Fai Kuo; Jiann-Shing Jeng

doi:10.1016/j.jns.2022.120408

Postoperative vascular event prediction using angiography and ultrasonography in patients with Moyamoya disease

J Neurol Sci. 2022 Nov 15:442:120408. doi: 10.1016/j.jns.2022.120408. Epub 2022 Sep 6.

Authors

Shin-Joe Yeh¹, Sung-Chun Tang¹, Li-Kai Tsai², Tzu-Ching Chen¹, Pei-Lin Li¹, Ya-Fang Chen³, Meng-Fai Kuo⁴, Jiann-Shing Jeng⁵

Affiliations

¹ Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
² Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan; Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
³ Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Neurosurgery, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: jsjeng@ntu.edu.tw.

PMID: 36108529
DOI: 10.1016/j.jns.2022.120408

Abstract

Objective: Indirect revascularization surgery reduce the risk of recurrent vascular events in patients with moyamoya disease (MMD), but the roles of postoperative angiography and ultrasonography in predicting these events remain unclear.

Methods: This prospective study enrolled patients with MMD who would undergo their first unilateral indirect revascularization surgery. They received preoperative and postoperative ultrasound examination at 1, 3, and 6 months and conventional cerebral angiography. On ultrasonography, postoperative emerging flow (PEF) in an intracranial artery was defined as emerging flow postoperatively with absence of flow preoperatively. Predictors of vascular event frequency reduction were identified from angiographic and ultrasonographic parameters.

Results: In total, 52 patients (including 24 pediatric and 24 male patients), who underwent 52 preoperative and 82 postoperative ultrasound examinations, were enrolled. Significant postoperative changes were noted in all the ultrasonographic parameters of ipsilateral superficial temporal artery (STA) and the end-diastolic velocity and flow volume in contralateral STA. During a median follow-up of 5.3 years, indirect revascularization surgery significantly reduced the occurrence of ipsilateral vascular events. Predictors of vascular event frequency reduction included Matsushima grade A or B on the ipsilateral side on angiography (odds ratio [OR] = 22.00, P = 0.002) and lower resistance index (RI) in ipsilateral STA (OR = 0.0001, P = 0.012) but no PEF pattern in ipsilateral middle cerebral artery (OR = 0.14, P = 0.029) on ultrasonography performed within 6 months.

Conclusions: Reduction of long-term vascular event frequency probably can be predicted through postoperative angiography and ultrasonography within 6 months after indirect revascularization surgery.

Keywords: Angiography; Moyamoya disease; Recurrent vascular events; Revascularization surgery; Ultrasonography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cerebral Angiography
Cerebral Revascularization*
Child
Humans
Male
Moyamoya Disease* / diagnostic imaging
Moyamoya Disease* / surgery
Prospective Studies
Treatment Outcome
Ultrasonography

Supplementary concepts

Moyamoya disease 1