2
|
Deckers PT, van Hoek W, Kronenburg A, Yaqub M, Siero JCW, Bhogal AA, van Berckel BNM, van der Zwan A, Braun KPJ. Contralateral improvement of cerebrovascular reactivity and TIA frequency after unilateral revascularization surgery in moyamoya vasculopathy. NEUROIMAGE-CLINICAL 2021; 30:102684. [PMID: 34215154 PMCID: PMC8102652 DOI: 10.1016/j.nicl.2021.102684] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/24/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022]
Abstract
Contralateral cerebrovascular reactivity may improve after unilateral surgery in moyamoya. TIA frequency from the contralateral hemisphere can decrease after unilateral moyamoya surgery. These findings support staged rather than direct bilateral surgery in moyamoya.
Objective Moyamoya vasculopathy is a rare, often bilateral disease characterized by progressive stenosis and occlusion of the distal internal carotid artery, leading to a progressive deterioration of cerebrovascular reactivity (CVR) and increased risk of transient ischemic attacks (TIAs), infarction and hemorrhage. Surgical revascularization is a widely accepted symptomatic treatment, often performed bilaterally in one or two stages. To possibly further optimize treatment strategy, we investigated the effect of unilateral revascularization surgery on the CVR of, and TIA frequency originating from, the contralateral hemisphere. Methods From our database of 143 moyamoya vasculopathy patients we selected those with bilateral disease, who underwent hemodynamic imaging ([15O]H2O positron emission tomography (PET)-CT with acetazolamide challenge) before and 14 months (median) after unilateral revascularization. We evaluated CVR in three regions per hemisphere, and averaged these per hemisphere for statistical comparison. Conservatively treated patients were showed as a comparison group. To examine TIA frequency, we selected patients who presented with TIAs that (also) originated from the contralateral – not to be operated – hemisphere. We scored changes in CVR and TIA frequency of the ipsilateral and contralateral hemisphere over time. Results Seven surgical and seven conservative patients were included for CVR comparison. Of the 20 scored contralateral regions in the surgical group, 15 showed improved CVR after unilateral revascularization, while 5 remained stable. The averaged scores improved significantly for both hemispheres. In conservatively treated patients, however, only 3 of the 20 scored regions improved in the least-affected (contralateral) hemispheres, and 9 deteriorated. From the 6 patients with contralateral TIAs at presentation, 4 had a decreased TIA frequency originating from the contralateral hemisphere after unilateral surgery, while 2 patients remained stable. Conclusion Both CVR and TIA frequency in the contralateral hemisphere can improve after unilateral revascularization surgery in bilateral MMV.
Collapse
Affiliation(s)
- Pieter T Deckers
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands.
| | - Wytse van Hoek
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Annick Kronenburg
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Jeroen C W Siero
- Imaging Division, Department of Radiology, Utrecht Center for Image Sciences, University Medical Center Utrecht, Utrecht the Netherlands; Spinoza Centre for Neuroimaging, Amsterdam, the Netherlands
| | - Alex A Bhogal
- Imaging Division, Department of Radiology, Utrecht Center for Image Sciences, University Medical Center Utrecht, Utrecht the Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Albert van der Zwan
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| |
Collapse
|
4
|
Strother MK, Anderson MD, Singer RJ, Du L, Moore RD, Shyr Y, Ladner TR, Arteaga D, Day MA, Clemmons PF, Donahue MJ. Cerebrovascular collaterals correlate with disease severity in adult North American patients with Moyamoya disease. AJNR Am J Neuroradiol 2014; 35:1318-24. [PMID: 24651814 DOI: 10.3174/ajnr.a3883] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebrovascular collaterals have been increasingly recognized as predictive of clinical outcomes in Moyamoya disease in Asia. The aim of this study was to characterize collaterals in North American adult patients with Moyamoya disease and to assess whether similar correlations are valid. MATERIALS AND METHODS Patients with Moyamoya disease (n = 39; mean age, 43.5 ±10.6 years) and age- and sex-matched control subjects (n = 33; mean age, 44.3 ± 12.0 years) were graded via angiography. Clinical symptoms of stroke or hemorrhage were graded separately by imaging. Correlations between collateralization and disease severity, measured by the modified Suzuki score, were evaluated in patients with Moyamoya disease by fitting a regression model with clustered ordinal multinomial responses. RESULTS The presence of leptomeningeal collaterals (P = .008), dilation of the anterior choroidal artery (P = .01), and the posterior communicating artery/ICA ratio (P = .004) all correlated significantly with disease severity. The presence of infarct or hemorrhage and posterior steno-occlusive disease did not correlate significantly with the modified Suzuki score (P = .1). Anterior choroidal artery changes were not specific for hemorrhage. Patients with Moyamoya disease were statistically more likely than controls to have higher posterior communicating artery/ICA ratios and a greater incidence of leptomeningeal collaterals. CONCLUSIONS As with Moyamoya disease in Asian patients, the presence of cerebrovascular collaterals correlated with the modified Suzuki score for disease severity in North American patients with Moyamoya disease. However, anterior choroidal artery changes, which correlated with increased rates of hemorrhage in Asian studies, were not specific to hemorrhage in North Americans.
Collapse
Affiliation(s)
- M K Strother
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - M D Anderson
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - R J Singer
- Section of Neurosurgery (R.J.S.), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - L Du
- Vanderbilt Center for Quantitative Sciences (L.D., Y.S.); Vanderbilt University School of Medicine, Nashville, Tennessee
| | - R D Moore
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - Y Shyr
- Vanderbilt Center for Quantitative Sciences (L.D., Y.S.); Vanderbilt University School of Medicine, Nashville, Tennessee
| | - T R Ladner
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - D Arteaga
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - M A Day
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - P F Clemmons
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - M J Donahue
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)Neurology (M.J.D.)Psychiatry (M.J.D)Physics and Astronomy (M.J.D.)
| |
Collapse
|
5
|
Jeong YG, Kim EH, Hwang SM, Lee GY, Kim JW, Choi YJ, Kwak JH, Suh DC. Outpatient (Same-day care) Neuroangiography and Neurointervention. Neurointervention 2012; 7:17-22. [PMID: 22454780 PMCID: PMC3299945 DOI: 10.5469/neuroint.2012.7.1.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 01/20/2012] [Indexed: 11/24/2022] Open
Abstract
Purpose There have been few reports regarding same-day discharge following uncomplicated procedures such as cerebral angiography and neurointervention. We present same-day experience with cerebral angiography and neurointervention during the past three years. Materials and Methods Four hundred and fifty-three patients underwent cerebral angiography or neurointervention at Asan Medical Center between January 2009 and December 2011. Of these patients, 249 (55%) underwent diagnostic catheter cerebral angiography and 204 patients (45%) underwent neurointerventional procedures as same-day procedures. We analyzed any complications, the modified patient-care process, the yearly trend in patient increases, disease categories, and the additional duration of admission for these procedures. Results The number of overall patients increased by an average of 51% annually. The disease categories included aneurysm (51%), atherosclerosis (11%) and arteriovenous malformation (10%), etc. for which the patient underwent angiography, and aneurysm (42%), venous malformation (28%), and arteriovenous malformation (17%), etc. for which patients underwent neurointervention. Same-day care patients were admitted to the intermediary care unit in the angiosuite. Neurointervention patients were sent to the neurology intensive unit after the procedure. The same-day care patients stayed in angiosuite for six hours following the transfemoral procedure. The mean admission duration for neurointervention was 2.4 days. There were no reported complications for the same-day care procedures. Conclusion Our study revealed an increasing tendency toward same-day care for patients who require angiography and neurointervention. Further studies will be required to better define the cost-minimization effects of outpatient practice as well as the patient perception of this fast-tracking method. We propose that outpatient angiography and neurointervention will undoubtedly continue to increase over the next decade.
Collapse
Affiliation(s)
- Yun-Gyeong Jeong
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Ideguchi R, Morikawa M, Enokizono M, Ogawa Y, Nagata I, Uetani M. Ivy signs on FLAIR images before and after STA-MCA anastomosis in patients with Moyamoya disease. Acta Radiol 2011; 52:291-6. [PMID: 21498365 DOI: 10.1258/ar.2011.100367] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Leptomeningeal high signal intensity (ivy sign) on fluid-attenuated inversion-recovery (FLAIR) MR imaging is one of the features of Moyamoya disease. However, the correlation between ivy sign and cerebral perfusion status has not been fully evaluated. PURPOSE To characterize ivy sign on FLAIR images in Moyamoya disease and compare this finding with hemodynamic alterations on perfusion single-photon emission CT (SPECT) obtained before and after bypass surgery. MATERIAL AND METHODS Sixteen patients with angiographically confirmed Moyamoya disease who underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis were included in the study. The presence of ivy sign on FLAIR images was classified as 'negative', 'minimal' and 'positive'. We evaluated the relationship between ivy sign and findings of SPECT, including cerebral vascular reserve (CVR) before and after surgery. RESULTS Minimal or positive ivy sign was seen in 13 (81%) of 16 patients, and 21 (66%) of 32 hemispheres. CVR in the areas with positive or minimal ivy sign was lower than that in the areas with negative ivy sign. After STA-MCA anastomosis, ivy sign disappeared or decreased in all 21 hemispheres demonstrating ivy sign. SPECT demonstrated apparent hemodynamic improvement in areas demonstrating disappearance or decrease of ivy sign. CONCLUSION Ivy sign on FLAIR image is seen in areas with decreased cerebral perfusion. The sign is useful for non-invasive assessment of cerebral hemodynamic status before and after surgery.
Collapse
Affiliation(s)
- Reiko Ideguchi
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | - Minoru Morikawa
- Department of Radiology, Nagasaki University School of Medicine, Nagasaki
| | - Mikako Enokizono
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | - Yoji Ogawa
- Department of Radiology, Hanwa Daini Senboku Hospital, Osaka
| | - Izumi Nagata
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| |
Collapse
|
7
|
Lee M, Guzman R, Bell-Stephens T, Steinberg GK. Intraoperative blood flow analysis of direct revascularization procedures in patients with moyamoya disease. J Cereb Blood Flow Metab 2011; 31:262-74. [PMID: 20588321 PMCID: PMC3049490 DOI: 10.1038/jcbfm.2010.85] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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.
Collapse
Affiliation(s)
- Marco Lee
- Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California 94305, USA
| | | | | | | |
Collapse
|