Yeh Shin-Joe, Tang Sung-Chun, Tsai Li-Kai, Lee Chung-Wei, Chen Ya-Fang, Liu Hon-Man, Yang Shih-Hung, Kuo Meng-Fai, Jeng Jiann-Shing
Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
PLoS One. 2017 Dec 8;12(12):e0188948. doi: 10.1371/journal.pone.0188948. eCollection 2017.
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.
烟雾病中由颅内动脉慢性进行性狭窄或闭塞引起的脑灌注不足可通过直接搭桥或间接血运重建术进行治疗。间接血运重建术后来自颈外动脉（ECA）的侧支循环程度是血管造影随访的关键，而血管造影的侵入性促使我们研究超声检查在侧支循环评估中的作用。我们假设血管造影显示的侧支循环可能在彩色多普勒超声检查中产生相应的血流动力学变化。我们前瞻性招募了接受间接血运重建手术并在术前和术后均接受血管造影和彩色多普勒超声检查的烟雾病患者。血管造影上的侧支循环根据松岛法分级。共纳入21例患者（年龄17±10.2岁），涉及24个手术半球。血管造影显示侧支循环建立较好的患者，其颞浅动脉（STA）和ECA的舒张末期速度（EDV）较高、阻力指数（RI）较低且血流量较大（均p<0.05）。在STA中，术后EDV增加大于13.5 cm/秒或RI降低大于0.19对应于松岛分级A+B的94%。在ECA中，术后EDV大于22 cm/秒或EDV增加大于6.4 cm/秒也对应于松岛分级A+B的94%。我们的研究结果揭示了彩色多普勒超声检查在识别间接血运重建术后侧支循环不良患者中的潜在作用。
