Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japann.
Nagoya J Med Sci. 2021 Aug;83(3):523-534. doi: 10.18999/nagjms.83.3.523.
In superficial temporal artery to middle cerebral artery anastomosis with indirect revascularization for patients with moyamoya disease, the optimal method for selecting the most appropriate cortical artery for the recipient in anastomosis has not been established. We investigated the relationship between the fluorescence emission timing of the recipient artery in the preanastomosis indocyanine green videoangiography and operative outcomes. This retrospective study included 51 surgical revascularization procedures for 39 moyamoya disease patients. The enrolled surgical procedures were classified into three groups based on the fluorescence emission timing of the recipient artery in preanastomosis indocyanine green videoangiography: the EARLIEST, the INTERMEDIATE, and the LATEST. Clinical characteristics and operative outcomes were also collected. The occurrence of white thrombus at the anastomosis site and symptomatic hyperperfusion showed significant differences between the groups classified by the fluorescence emission timing of the recipient artery in preanastomosis indocyanine green videoangiography (white thrombus, p = 0.001; symptomatic hyperperfusion, p = 0.026). The development of white thrombi was significantly higher in the LATEST group, and all symptomatic hyperperfusion was observed in the EARLIEST group. These results indicated that the LATEST group had a significantly higher risk for developing white thrombus, and the EARLIEST group was prone to occur symptomatic hyperperfusion. Selecting the recipient artery based on evaluating the fluorescence emission timing in preanastomosis indocyanine green videoangiography may be useful in reducing perioperative complications.
在颞浅动脉-大脑中动脉吻合术联合间接血运重建治疗烟雾病患者中，尚未确定选择最合适的吻合受区皮质动脉的最佳方法。我们研究了吻合术前吲哚菁绿视频血管造影中受区动脉荧光发射时间与手术结果的关系。这项回顾性研究纳入了 39 例烟雾病患者的 51 例手术血运重建。根据吻合术前吲哚菁绿视频血管造影中受区动脉的荧光发射时间，将纳入的手术程序分为三组：EARLIEST、INTERMEDIATE 和 LATEST。还收集了临床特征和手术结果。吻合部位白色血栓形成和症状性过度灌注的发生率在根据吻合术前吲哚菁绿视频血管造影中受区动脉荧光发射时间分组的组之间存在显著差异（白色血栓形成，p=0.001；症状性过度灌注，p=0.026）。LATEST 组的白色血栓形成发生率明显更高，而 EARLIEST 组则观察到所有症状性过度灌注。这些结果表明，LATEST 组发生白色血栓形成的风险显著更高，而 EARLIEST 组则容易发生症状性过度灌注。基于吻合术前吲哚菁绿视频血管造影中荧光发射时间来选择受区动脉可能有助于减少围手术期并发症。
