Hemodynamic Changes after Unilateral Revascularization for Moyamoya Disease: Serial Assessment by Quantitative Magnetic Resonance Angiography.
BACKGROUND
Ultrasonic flow meters and quantitative magnetic resonance angiography quantitatively assess flow during hemodynamic evaluation of cerebral ischemia. Although their reliability and reproducibility have been verified, their clinical impact in moyamoya disease has rarely been reported.


OBJECTIVE
To investigate flow measurement outcomes in moyamoya disease patients pre- and postoperatively through a retrospective observational study.


METHODS
We evaluated 41 patients undergoing their first revascularization surgery who were followed ≥6 mo. Hemodynamic parameters were recorded preoperatively, at 1 and 6 mo postoperatively, and at the last follow-up. Demographic factors, Suzuki stage, and stroke development were also analyzed.


RESULTS
Patients' median age was 37 yr (interquartile range [IQR], 27-43), and 16 (39.0%) patients were men. During follow-up, 9 (22.0%) patients experienced postoperative stroke (4 major strokes). Hemodynamic status was improved in 34 (82.9%) patients at the 6-mo follow-up. Median intraoperative flow was 41 mL/min (IQR, 25-59). Bypass flow peaked at 6 mo (median, 67 mL/min; IQR, 35-99). At the 1- and 6-mo follow-ups, ipsilateral hemispheric flow was significantly increased. The median proportion of posterior circulation at 6 mo was 44.4%, significantly lower than the preoperative proportion (50.1%). Abundant intraoperative bypass flow was associated with hemodynamic improvement, while low contralateral hemispheric flow was related with immediate postoperative ischemic stroke.


CONCLUSIONS
Ipsilateral hemispheric flow was increased during 6-mo follow-up, and posterior circulation flow burden was diminished. Abundant intraoperative bypass flow was associated with postoperative hemodynamic improvement. Low preoperative contralateral hemispheric flow was related with immediate postoperative ischemic stroke.
Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.|Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Tackeun
T
Kim
Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.|Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Jae Seung
JS
Bang
Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.|Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
O-Ki
OK
Kwon
Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.|Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Gyojun
G
Hwang
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.|Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Jeong Eun
JE
Kim
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.|Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Hyun-Seung
HS
Kang
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.|Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Won-Sang
WS
Cho
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.|Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Cheolkyu
C
Jung
Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.|Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Chang Wan
CW
Oh
D000328:Adult; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D005260:Female; D006439:Hemodynamics; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
Cerebral revascularization; Cerebrovascular disorders; Flow measurement; Hemodynamic; Magnetic resonance angiography; Moyamoya disease; Quantitative