title: Intraoperative blood flow analysis of direct revascularization procedures in patients with moyamoya disease.
abstract: Moyamoya disease is characterized by the progressive stenosis and often occlusion of the terminal internal carotid arteries, which leads to ischemic and hemorrhagic injuries. The etiology is unknown and surgical revascularization remains the mainstay treatment. We analyzed various hemodynamic factors in 292 patients with moyamoya disease, representing 496 revascularization procedures, including vessel dimension and intraoperative blood flow, using a perivascular ultrasonic flowprobe. Mean middle cerebral artery (MCA) flow rate was 4.4 ± 0.26 mL/min. After superficial temporal artery (STA)-MCA bypass surgery, flows at the microanastomosis were increased fivefold to a mean of 22.2 ± 0.8 mL/min. The MCA flows were significantly lower in the pediatric (16.2 ± 1.3 mL/min) compared with the adult (23.9 ± 1.0 mL/min; P<0.0001) population. Increased local flow rates were associated with clinical improvement. Permanent postoperative complications were low (<5%), but very high postanastomosis MCA flow was associated with postoperative stroke (31.2 ± 6.8 mL/min; P=0.045), hemorrhage (32.1 ± 10.2 mL/min; P=0.045), and transient neurologic deficits (28.6 ± 5.6 mL/min; P=0.047) compared with controls. Other flow and vessel dimension data are presented to elucidate the hemodynamic changes related to the vasculopathy and subsequent to surgical intervention.
authors.affiliation: Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California 94305, USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Lee
authors.forename: Raphael
authors.initials: R
authors.lastname: Guzman
authors.forename: Teresa
authors.initials: T
authors.lastname: Bell-Stephens
authors.forename: Gary K
authors.initials: GK
authors.lastname: Steinberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology; D000714:Anastomosis, Surgical; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006400:Hematocrit; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology / Q000502:physiology; D009072:Moyamoya Disease / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D009422:Nervous System Diseases / Q000209:etiology; D011183:Postoperative Complications / Q000503:physiopathology; D012727:Sex Characteristics; D020521:Stroke / Q000209:etiology / Q000473:pathology; D013699:Temporal Arteries / Q000473:pathology / Q000502:physiology; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide