Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
Ultrasound Med Biol. 2024 Nov;50(11):1595-1601. doi: 10.1016/j.ultrasmedbio.2024.05.025. Epub 2024 Aug 3.
Recurrent stroke after revascularization surgeries predicts poor outcome in patients with moyamoya disease (MMD). Early identification of patients with stroke risk paves the way for rescue intervention. This study aimed to investigate the role of ultrasound in identifying patients at risk of post-operative ischemic events (PIEs).
This prospective study enrolled patients with symptomatic MMD who underwent indirect revascularization surgeries. Ultrasound examinations were performed preoperatively and at 3 mo post-operatively to evaluate the hemodynamic changes in extracranial and intracranial arteries on the operated side. PIE was defined as ischemic stroke or transient ischemic attack in the operated hemisphere within 1 y. The areas under receiver operating characteristic curves were compared between models for prediction of PIE.
A total of 56 operated hemispheres from 36 patients (mean age, 23.0 ± 18.5 y) were enrolled in this study, and 27% developed PIE. In multivariate logistic regression models, PIE was associated with lower end-diastolic velocity and flow volume (FV) of the ipsilateral external carotid artery (ECA), and lower FV of ipsilateral superficial temporal artery and occipital artery at 3 mo post-operatively (all p < 0.05). Moreover, the post-operative FV of the ipsilateral ECA was the only one factor that significantly increased the areas under receiver operating characteristic curves from 0.727 to 0.932 when adding to a clinical-angiographic model for prediction of PIE (p = 0.017). This parameter was significantly lower in hemispheres with PIE, both in adult and pediatric patients.
After indirect revascularization, surgeries in patients with symptomatic MMD, FV of ipsilateral ECA at 3 mo helps clinicians to identify patients at risk of PIE.
血运重建手术后的复发性卒中预示着烟雾病（MMD）患者预后不良。早期识别具有卒中风险的患者为抢救性干预铺平了道路。本研究旨在探讨超声在识别术后缺血性事件（PIE）风险患者中的作用。
这项前瞻性研究纳入了接受间接血运重建手术的有症状 MMD 患者。在术前和术后 3 个月进行超声检查，以评估手术侧颅外和颅内动脉的血流动力学变化。PIE 定义为手术侧半球在 1 年内发生缺血性卒中和短暂性脑缺血发作。比较模型预测 PIE 的受试者工作特征曲线下面积。
本研究共纳入 36 例患者 56 个手术侧半球（平均年龄 23.0±18.5 岁），27%发生 PIE。多变量逻辑回归模型显示，PIE 与同侧颈外动脉（ECA）舒张末期速度和流量（FV）较低，以及术后 3 个月同侧颞浅动脉和枕动脉 FV 较低相关（均 p<0.05）。此外，术后同侧 ECA 的 FV 是唯一在添加到预测 PIE 的临床-血管造影模型后显著增加受试者工作特征曲线下面积的因素，从 0.727 增加到 0.932（p=0.017）。在有 PIE 的半球中，该参数均显著低于成人和儿童患者。
在有症状 MMD 患者接受间接血运重建手术后，3 个月时同侧 ECA 的 FV 有助于临床医生识别具有 PIE 风险的患者。
