Clinical Prediction of Surgical Revascularization Outcome in Moyamoya Disease Via Transcranial Color Sonography

J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105154. doi: 10.1016/j.jstrokecerebrovasdis.2020.105154. Epub 2020 Aug 26.

Abstract

Objective: Transcranial color-duplex sonography (TCCS) is a promising method in evaluating the hemodynamics in patients with moyamoya disease (MMD). This study aimed to explore the feasibility of preoperative TCCS in predicting the outcome of revascularization surgery in MMD patients.

Methods: We retrospectively analysed 64 cases of MMD patients receiving revascularization surgery from January 2012 to January 2014. We utilized TCCS to perform comprehensive hemodynamic examination on the hemodynamics of bilateral intracranial and extracranial cerebrovascular flow and assessed the surgical outcomes and prognosis through the longitudinal comparison of the preoperative and postoperative cerebrovascular hemodynamics. Occurrence of bypass blockage was regarded as surgical failure.

Results: We established a prediction model for bypass blockage among MMD patients with an AUC of 0.858 (95% CI: 0.666-1). The parameters, EDV of ECA and PSV of MA obtained by the model are the main preoperative predictors for bypass blockage.

Conclusions: TCCS could preoperatively determine the degree of MMD and evaluate the outcome of revascularization surgery. It also is a feasible tool to predict the curative effect by providing preoperative hemodynamic information.

Keywords: Cerebral angiography; Hemodynamics; Moyamoya disease; Surgical revascularization; Transcranial color sonography.

MeSH terms

  • Adult
  • Cerebral Revascularization* / adverse effects
  • Cerebrovascular Circulation
  • Feasibility Studies
  • Female
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Moyamoya Disease / diagnostic imaging*
  • Moyamoya Disease / physiopathology
  • Moyamoya Disease / surgery*
  • Predictive Value of Tests
  • Retrospective Studies
  • Severity of Illness Index
  • Treatment Outcome
  • Ultrasonography, Doppler, Color*
  • Ultrasonography, Doppler, Transcranial*
  • Young Adult