Evaluation of Hemodynamic Change by Indocyanine Green-FLOW 800 Videoangiography Mapping: Prediction of Hyperperfusion Syndrome in Patients with Moyamoya Disease
Evaluation of Hemodynamic Change by Indocyanine Green-FLOW 800 Videoangiography Mapping: Prediction of Hyperperfusion Syndrome in Patients with Moyamoya Disease
复制标题
通过 Indocyanine Green-FLOW 800 视频血管造影映射评估血流动力学变化：预测烟雾病患者的过度灌注综合征
DOI：
10.1155/2020/8561609
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发表时间：
2020-08-12
影响因子：
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通讯作者：
Gu, Yuxiang
中科院分区：
文献类型：
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作者：
Zhang, Xin;Ni, Wei;Gu, Yuxiang
目的烟雾病（moyamoya disease，MMD）搭桥术后高灌注综合征（hyperperfusionsyndrome，HPS）主要是由于血流再分布所致，预后差，目前尚缺乏有效的预测方法。吲哚菁绿色（ICG）视频血管造影可应用FLOW 800软件半定量评价局部脑血流变化。本研究的目的是研究使用FLOW 800视频血管造影标测对吻合部位周围局部血流动力学变化的术中评价是否可以预测HPS的发生率和临床结局。方法对2018年8月至2019年12月在我院接受颞浅动脉-大脑中动脉搭桥术的MMD患者中的62例患者的65个半球进行研究，使用FLOW 800（Zeiss Meditec，上科亨，德国）进行术中ICG分析，以评估吻合前后局部脑血流动力学。根据受区动脉在手术区域的位置和情况，在脑表面2点以上设置感兴趣区。从选定的点计算峰值脑血容量（CBV）、局部脑血流量（CBF）和达峰时间（TTP）。由于术中数据可用，因此在合适的区域进行了手术。根据HPS的发生情况，将患者分为无症状组和有症状组，比较两组患者的血流动力学参数。此外，进行ROC分析以确定CBV、CBF和TTP变化率的诊断准确性（即，ΔCBV、ΔCBF和ΔTTP）用于预测HPS。结果分析了62例患者的数据，所有患者在术后住院期间进行了密切评估。有症状组的ΔCBV和ΔCBF值显著较高（p < 0.01），而ΔTTP在有症状组中略低，无统计学差异（p = 0.72）。根据ROC曲线，FLOW 800计算的血流动力学参数包括ΔCBV和ΔCBF具有较高的敏感性和特异性（ΔCBV：AUC = 0.743，95%CI，0.605-0.881，p = 0.002; ΔCBF：AUC = 0.852，95%CI，0.750-0.954，p < 0.01），可作为HPS的预测指标。结论术中ICG-FLOW 800视频血管造影是一种安全的方法，能反映MMD手术区域的血流动力学特征，其结果与HPS的发生相关。结果表明，ΔCBV和ΔCBF是预测HPS的有效参数。
Objective Hyperperfusion syndrome (HPS) after bypass surgery for moyamoya disease (MMD) mainly results from redistribution of blood flow, which leads to poor outcomes, while effective methods to predict HPS are still lacking. Indocyanine green (ICG) videoangiography can assess regional cerebral blood flow changes semiquantitatively with the application of FLOW 800 software. The purpose of this study was to investigate whether the intraoperative evaluation of local hemodynamic changes around anastomotic sites using FLOW 800 videoangiography mapping can predict the incidence of HPS and clinical outcomes. Methods Of the patients who were diagnosed with MMD in our hospital between August 2018 and December 2019, who underwent superficial temporal artery-middle cerebral artery bypass surgeries, we investigated 65 hemispheres (in 62 patients) in which intraoperative ICG analysis was performed using FLOW 800 (Zeiss Meditec, Oberkochen, Germany) to evaluate the local cerebral hemodynamics before and after anastomosis. Regions of interest were set at more than 2 points on the brain surface according to the location and situation of recipient arteries in the surgical area. Peak cerebral blood volume (CBV), regional cerebral blood flow (CBF), and time to peak (TTP) were calculated from the selected points. As the data were available intraoperatively, anastomoses were performed in a suitable area. According to the occurrence of HPS, patients were divided into the asymptomatic and symptomatic groups, from which hemodynamic parameters were compared. Furthermore, ROC analysis was performed to determine the diagnostic accuracy of change rates in CBV, CBF, and TTP (i.e., ΔCBV, ΔCBF, and ΔTTP) for predicting HPS. Results Data from the 62 patients were analyzed, and all patients were closely assessed during hospitalization after the procedures. The values of ΔCBV and ΔCBF were significantly higher in the symptomatic group (p < 0.01), while ΔTTP is slightly lower in the symptomatic group with no statistical differences (p = 0.72). Hemodynamic parameters including ΔCBV and ΔCBF, calculated by FLOW 800, had high sensitivity and specificity according to the ROC curve (ΔCBV: AUC = 0.743, 95% CI, 0.605–0.881, p = 0.002; ΔCBF: AUC = 0.852, 95% CI, 0.750–0.954, p < 0.01), which could be used as predictors for HPS. Conclusions Intraoperative ICG-FLOW 800 videoangiography mapping is a safe method which can reflect hemodynamic characteristics in the surgical area for MMD, the findings of which correlate with the occurrence of HPS. Parameters including ΔCBV and ΔCBF are proven to be efficient in the prediction of HPS.