Color Doppler ultrasonography as an alternative tool for postoperative evaluation of collaterals after indirect revascularization surgery in Moyamoya disease
Journal
PLoS ONE
Journal Volume
12
Journal Issue
12
Pages
e0188948
Date Issued
2017
Abstract
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. ? 2017 Yeh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
adolescent; adult; Article; blood flow velocity; brain angiography; brain blood flow; brain vascular resistance; cerebral revascularization; child; clinical article; clinical evaluation; collateral circulation; color Doppler flowmetry; craniotomy; diastole; external carotid artery; female; follow up; hemisphere; human; male; moyamoya disease; postoperative period; preoperative evaluation; preschool child; school child; superficial temporal artery; young adult; cerebral revascularization; color Doppler flowmetry; diagnostic imaging; moyamoya disease; procedures; Adolescent; Adult; Cerebral Revascularization; Child; Child, Preschool; Female; Humans; Male; Moyamoya Disease; Postoperative Period; Ultrasonography, Doppler, Color; Young Adult
Type
journal article