Koc Natalia Anna, Rakowski Maurycy, Pettersson Samuel D, Skrzypkowska Paulina, Szmuda Tomasz, Zieliński Piotr
Department of Neurosurgery, Medical University of Gdańsk, Gdańsk, Poland.
Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Acta Neurochir (Wien). 2025 Sep 10;167(1):242. doi: 10.1007/s00701-025-06658-6.
Moyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive arterial stenosis and fragile collateral formation, elevating stroke risk. Revascularization is the standard treatment, yet up to 27% of patients experience ischemic events within a year due to bypass insufficiency. While digital subtraction angiography (DSA) remains the gold standard for assessing bypass function, it is invasive and time-consuming. This study evaluates ultrasonography (US) as a noninvasive, cost-effective tool to assess bypass capacity post-revascularization in MMD.
A systematic search was conducted following PRISMA guidelines. PubMed, Web of Science, and Scopus were searched for studies reporting US parameters with control imaging confirming bypass capacity. Study quality was assessed using the Newcastle-Ottawa Scale. Mean difference (MD) values were calculated using random-effects models. High bypass capacity was defined as good patency or favorable collateral development.
Eight cohort studies comprising 264 MMD patients and 301 operated hemispheres were included, with 180 demonstrating high bypass capacity. Within two weeks post-surgery, increased superficial temporal artery (STA) peak systolic velocity (PSV, MD = 28.26, p < 0.0001), mean flow velocity (MFV, MD = 22.97, p = 0.03), end-diastolic velocity (EDV, MD = 33.45, p < 0.0001), and decreased resistance index (RI, MD = -0.09, p = 0.006) were predictive. External carotid artery (ECA) EDV (MD = 13.92, p = 0.04) was also significant. At 3-6 months, elevated EDV in both STA (MD = 8.13, p = 0.006) and ECA (MD = 8.71, p = 0.0002) remained predictive. In the indirect subgroup, lower anterior cerebral artery (ACA) MFV within 0-3 months predicted favorable outcomes (MD = -64.98, p = 0.001).
Changes in STA and ECA US parameters measured following revascularization surgery predict high bypass capacity. Decreased ACA MFV suggests effective revascularization after indirect surgery. Ultrasound modality offers a valuable, noninvasive tool for postoperative assessment in MMD.
烟雾病（MMD）是一种慢性脑血管疾病，其特征为进行性动脉狭窄和脆弱的侧支循环形成，从而增加中风风险。血运重建是标准治疗方法，但由于搭桥不足，高达27%的患者在一年内会发生缺血性事件。虽然数字减影血管造影（DSA）仍然是评估搭桥功能的金标准，但它具有侵入性且耗时。本研究评估超声检查（US）作为一种无创、经济有效的工具，用于评估MMD血运重建术后的搭桥能力。
按照PRISMA指南进行系统检索。在PubMed、科学网和Scopus上检索报告超声参数且有对照成像证实搭桥能力的研究。使用纽卡斯尔-渥太华量表评估研究质量。使用随机效应模型计算平均差值（MD）值。高搭桥能力定义为通畅良好或侧支循环发育良好。
纳入了8项队列研究，包括264例MMD患者和301个手术半球，其中180个显示高搭桥能力。术后两周内，颞浅动脉（STA）收缩期峰值流速（PSV，MD = 28.26，p < 0.0001）、平均流速（MFV，MD = 22.97，p = 0.03）、舒张末期流速（EDV，MD = 33.45，p < 0.0001）升高以及阻力指数（RI，MD = -0.09，p = 0.006）降低具有预测性。颈外动脉（ECA）的EDV（MD = 13.92，p = 0.04）也具有显著性。在3 - 6个月时，STA（MD = 8.13，p = 0.006）和ECA（MD = 8.71，p = 0.0002）的EDV升高仍然具有预测性。在间接手术亚组中，0 - 3个月内大脑前动脉（ACA）较低的MFV预测了良好的预后（MD = -64.98，p = 0.001）。
血运重建手术后测量的STA和ECA超声参数变化可预测高搭桥能力。ACA的MFV降低表明间接手术后血运重建有效。超声检查为MMD术后评估提供了一种有价值的无创工具。
