Xu Liang, Li Yin, Tong Yun, Hu Jun-Wen, He Xu-Chao, Fu Xiong-Jie, Zhou Guo-Yang, Cao Yang, Yu Xiao-Bo, Zhou Hang, Xu Chao-Ran, Wang Lin
Department of Neurosurgery, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China.
Front Neurol. 2022 May 16;13:890126. doi: 10.3389/fneur.2022.890126. eCollection 2022.
In moyamoya disease (MMD) with direct or combined revascularization, the initially hemodynamic recipient features are likely one of the main causes of acute hemodynamic disruption. Previous studies have explored the relationship between recipient diameter or flow velocity and postoperative complications, but there are still no optimal selection criteria with multiple potential recipient vessels. Cerebral edema is one of the most common radiological manifestations in the acute postoperative period. This study assessed the hemodynamic characteristics of cortex vessels related to postoperative cerebral edema.
All patients who had undergone direct or combined revascularization with preoperative digital subtraction angiography (DSA) between 2019 and 2021 were eligible for inclusion in this study. The application of DSA was performed and regular radiological examinations were employed after surgery. DSA was analyzed with the hemodynamic features within chosen recipient vessels. Cerebral edema was identified as a low-density image on CT or high signaling in the MRI T2 phase. The recipient hemodynamic characteristics and demographic presentation, as well as clinical data, were retrospectively analyzed in this study.
A total of 103 patients underwent direct or combined revascularization with preoperative DSA. The mean age of this enrolled cohort was 44.31 ± 10.386 years, in which bilaterally involved MMD accounted for the main part. The preliminary correlation analysis found preoperative disease period ( = 0.078), recipients observed in angiography ( = 0.002), and surgery on the left ( = 0.097) may be associated with cerebral edema. The following regression analysis confirmed low occurrence of cerebral edema was accompanied by recipients observed in angiography ( = 0.003). After subdividing by flow direction and hemodynamic sources, the incidence rate of anterograde direction, anterior sources, and posterior sources were significantly lower than undetected recipients.
Cerebral edema is a common radiological manifestation in MMDs after surgery. In this study, the observation in angiography reliably identifies a variety of physiological or pathological recipient detection, flow direction, and hemodynamic sources in patients with MMD after revascularization, which indicates the selection strategy of potential recipients and highlights the importance of recipient observability in DSA. Meanwhile, vascular conditions determined by recipient hemodynamics meditate the occurrence of postoperative cerebral edema.
在直接或联合血管重建的烟雾病（MMD）中，最初的血流动力学受血特征可能是急性血流动力学破坏的主要原因之一。以往研究探讨了受血直径或流速与术后并发症之间的关系，但对于多个潜在受血血管仍没有最佳选择标准。脑水肿是术后急性期最常见的影像学表现之一。本研究评估了与术后脑水肿相关的皮质血管血流动力学特征。
所有在2019年至2021年间接受术前数字减影血管造影（DSA）的直接或联合血管重建患者均符合纳入本研究的条件。进行DSA检查，并在术后进行定期影像学检查。对所选受血血管内的血流动力学特征进行DSA分析。脑水肿在CT上表现为低密度影像，在MRI T2期表现为高信号。本研究对受血血流动力学特征、人口统计学特征以及临床数据进行了回顾性分析。
共有103例患者接受了术前DSA的直接或联合血管重建。该纳入队列的平均年龄为44.31±10.386岁，其中双侧受累的MMD占主要部分。初步相关性分析发现术前病程（=0.078）、血管造影中观察到的受血血管（=0.002）以及左侧手术（=0.097）可能与脑水肿有关。随后的回归分析证实血管造影中观察到的受血血管与脑水肿发生率较低相关（=0.003）。按血流方向和血流动力学来源细分后，顺行方向、前向来源和后向来源的发生率显著低于未检测到的受血血管。
脑水肿是MMD术后常见的影像学表现。在本研究中，血管造影观察可靠地识别了MMD血管重建术后患者各种生理或病理受血血管检测、血流方向和血流动力学来源，这表明了潜在受血血管的选择策略，并突出了DSA中受血血管可观察性的重要性。同时，由受血血流动力学决定的血管状况介导了术后脑水肿的发生。
