Kim Tackeun, Bang Jae Seung, Kwon O-Ki, Hwang Gyojun, Kim Jeong Eun, Kang Hyun-Seung, Cho Won-Sang, Jung Cheolkyu, Oh Chang Wan
Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Neurosurgery. 2017 Jul 1;81(1):111-119. doi: 10.1093/neuros/nyw035.
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.
To investigate flow measurement outcomes in moyamoya disease patients pre- and postoperatively through a retrospective observational study.
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.
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.
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.
在脑缺血的血流动力学评估中，超声流量计和定量磁共振血管造影可对血流进行定量评估。尽管它们的可靠性和可重复性已得到验证，但在烟雾病中的临床影响鲜有报道。
通过一项回顾性观察研究，调查烟雾病患者术前和术后的血流测量结果。
我们评估了41例接受首次血运重建手术且随访时间≥6个月的患者。记录术前、术后1个月和6个月以及最后一次随访时的血流动力学参数。还分析了人口统计学因素、铃木分期和中风发生情况。
患者的中位年龄为37岁（四分位间距[IQR]，27 - 43岁），16例（39.0%）为男性。随访期间，9例（22.0%）患者发生术后中风（4例为严重中风）。6个月随访时，34例（82.9%）患者的血流动力学状态得到改善。术中中位血流量为41 mL/分钟（IQR，25 - 59）。搭桥血流量在6个月时达到峰值（中位值，67 mL/分钟；IQR，35 - 99）。在术后1个月和6个月的随访中，同侧半球血流量显著增加。6个月时后循环的中位比例为44.4%，显著低于术前比例（50.1%）。术中丰富的搭桥血流量与血流动力学改善相关，而对侧半球低血流量与术后即刻缺血性中风相关。
在6个月的随访期间，同侧半球血流量增加，后循环血流负担减轻。术中丰富的搭桥血流量与术后血流动力学改善相关。术前对侧半球低血流量与术后即刻缺血性中风相关。
