Quantitative Angiographic Hemodynamic Evaluation After Revascularization Surgery for Moyamoya Disease
Quantitative Angiographic Hemodynamic Evaluation After Revascularization Surgery for Moyamoya Disease
复制标题
烟雾病血运重建手术后的定量血管造影血流动力学评估
DOI：
10.1007/s12975-020-00781-5
复制
发表时间：
2020-02-13
影响因子：
6.9
通讯作者：
Zhao, Yuanli
中科院分区：
文献类型：
--
作者：
Chen, Yu;Ma, Li;Zhao, Yuanli
烟雾病（MMD）血运重建术后颈内动脉（伊卡）的血流动力学变化尚不清楚。本研究的目的是分析直接和间接颅外-颅内（EC-IC）联合搭桥术后同侧伊卡的血流动力学变化。回顾性分析了接受EC-IC联合旁路术的MMD患者。在血管重建前和随访时通过彩色编码血管造影评价伊卡的平均通过时间（MTT）。MTT定义为颈内动脉颈段末端（C1）与伊卡段C7之间的血液通过时间。采用Matsushima分级系统、烟雾血管还原系统和改良兰金量表（mRS）评估临床预后。分析血流动力学参数与预后的相关性。亚组分析是在不同表现和不同年龄之间进行的。确定了51例患者，平均成像随访间隔为5.5个月。与对侧伊卡比较，联合血运重建后ICA-MTT明显升高（P< 0.001）。在缺血组中，更快的术前ICA-MTT与改善的mRS显著相关（P= 0.05）。ICA-MTT的增加与良好的新生血管形成（P= 0.04）、烟雾血管减少（> 50%）（P= 0.023）和mRS评分改善（P= 0.008）显著相关。在亚组分析中，缺血亚组和成人亚组的相关性仍然显著。在该队列中，EC-IC联合旁路术后ICA-MTT增加，血液通过时间增加与良好结局呈正相关。彩色编码DSA被证明是一种有用的定量和连续的方法来监测术后过程中MMD血运重建。
The corresponding hemodynamic changes of the internal carotid artery (ICA) after the revascularization surgery for moyamoya disease (MMD) remain unclear. The aim of this study was to analyze the hemodynamic changes of the ipsilateral ICA after the combined direct and indirect extracranial-intracranial (EC-IC) bypass. MMD patients undergoing combined EC-IC bypass were retrospectively reviewed. The mean transit time (MTT) of ICA was evaluated by color-coding angiography before revascularization and at follow-up. The MTT defined as the blood transit time between the end of cervical portion (C1) and the C7 segment of ICA. The clinical prognosis was assessed with Matsushima grading system, moyamoya vessel reduction system, and modified Rankin Scale (mRS). The correlation between hemodynamic parameter and prognosis was analyzed. Subgroup analysis was conducted between different presentations and different ages. Fifty-one patients were identified and the mean imaging follow-up interval was 5.5 months. The ICA-MTT was increased after the combined revascularization (P< 0.001) compared with contralateral ICA. Faster preoperative ICA-MTT was significantly associated with improved mRS in the ischemic group (P= 0.05). The increased ICA-MTT was significantly associated with favorable neoangiogenesis (P= 0.04), moyamoya vessel reduction (> 50%) (P= 0.023), and improved mRS score (P= 0.008). In subgroup analysis, the correlation in the ischemic subgroup and adult subgroup remained significant. In this cohort, the ICA-MTT increased after the combined EC-IC bypass, and there was a positive correlation between the increased blood transit time and favorable outcomes. Color-coding DSA proved to be useful as a quantitative and serial method to monitor postoperative courses after revascularization in MMD.