Han Shoumeng, Cai Linzhi, Tian Qi, Wei Heng, Wang Guijun, Wang Jianfeng, He Peibang, Liao Jianming, Zhang Shenqi, Chen Qianxue, Li Mingchang
Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China.
Quant Imaging Med Surg. 2023 Jan 1;13(1):293-308. doi: 10.21037/qims-22-407. Epub 2022 Nov 16.
Moyamoya disease (MMD) is a teratogenic and lethal disease. However, existing studies do not sufficiently indicate the impact factors. Therefore, we investigated the different impact factors on cerebral hemodynamics after revascularization in patients with MMD.
We retrospectively collected the clinical data of 233 adult patients with MMD who underwent revascularization surgery in the Department of Neurosurgery, Renmin Hospital of Wuhan University, from January 2015 to June 2021 for this retrospective cohort study. We analyzed the effects on hemodynamic improvement of age, sex, stroke type, early symptoms, Suzuki stage, history of hypertension, history of diabetes, and history of hyperlipidemia in patients with MMD. We also evaluated the efficacy of different revascularization strategies and we verified the effect of computed tomography perfusion (CTP) in evaluating cerebral hemodynamics.
The CTP values demonstrated that δ cerebral blood volume (CBV) values were significantly higher in the combined group [1.01 (0.87-1.75)] relative to those in the indirect group [1.34 (1.01-1.63); P=0.027]. There was no statistical significance in the improvement of clinical symptoms and clinical prognosis between the indirect and combined groups. Patients with MMD with diabetes [δ mean transit time (MTT), 0.49 (0.35-0.70) 0.72 (0.52-0.87); P<0.001] or calcium channel blocker (CCB) [δCBV, 1.46 (1.10-1.83) 1.12 (0.93-1.54); P=0.001] had better cerebral hemodynamics than patients in non-diabetic group or non-CCB group after revascularization.
We didn't find differences in clinical outcome between indirect and combined revascularization in patients with MMD. we demonstrated that CTP values can be used as a way to detect postoperative cerebral hemodynamic changes in MMD patients. Interestingly, we found that MMD patients with diabetes or CCB showed better cerebral perfusion after revascularization.
烟雾病（MMD）是一种致畸性和致死性疾病。然而，现有研究并未充分指出其影响因素。因此，我们调查了烟雾病患者血运重建后脑血流动力学的不同影响因素。
我们回顾性收集了2015年1月至2021年6月在武汉大学人民医院神经外科接受血运重建手术的233例成年烟雾病患者的临床资料，进行这项回顾性队列研究。我们分析了年龄、性别、卒中类型、早期症状、铃木分期、高血压病史、糖尿病病史和高脂血症病史对烟雾病患者血流动力学改善的影响。我们还评估了不同血运重建策略的疗效，并验证了计算机断层扫描灌注（CTP）在评估脑血流动力学方面的作用。
CTP值显示，联合组的δ脑血容量（CBV）值[1.01（0.87 - 1.75）]相对于间接组[1.34（1.01 - 1.63）；P = 0.027]显著更高。间接组和联合组在临床症状改善和临床预后方面无统计学意义。烟雾病合并糖尿病的患者[δ平均通过时间（MTT），0.49（0.35 - 0.70）对0.72（0.52 - 0.87）；P < 0.001]或使用钙通道阻滞剂（CCB）的患者[δCBV，1.46（1.1０ - 1.83）对1.12（0.93 - 1.54）；P = 0.001]血运重建后比非糖尿病组或非CCB组患者具有更好的脑血流动力学。
我们未发现烟雾病患者间接血运重建和联合血运重建在临床结局上存在差异。我们证明CTP值可作为检测烟雾病患者术后脑血流动力学变化的一种方法。有趣的是，我们发现合并糖尿病或使用CCB的烟雾病患者血运重建后脑灌注更好。
