Preoperatively estimated graft flow rate contributes to the improvement of hemodynamics in revascularization for Moyamoya disease
Preoperatively estimated graft flow rate contributes to the improvement of hemodynamics in revascularization for Moyamoya disease
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DOI：
10.1016/j.jstrokecerebrovasdis.2020.105450
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发表时间：
2021-01-01
影响因子：
2.5
通讯作者：
Mikuni, Nobuhiro
中科院分区：
文献类型：
--
作者：
Kuribara, Tomoyoshi;Mikami, Takeshi;Mikuni, Nobuhiro
目的：颞浅动脉(STA)-大脑中动脉(MCA)搭桥术是治疗Moyamoya病的有效方法，术后血流动力学参数有明显改善。然而，从移植物的术前解剖结构的角度来研究移植物的血流动力学变化尚无报道。在这项研究中，我们评估了通过基于图像的计算流体动力学(CFD)分析获得的移植物的术前血流量与血运重建后急性期血流动力学变化之间的相关性。材料和方法：对23例患者30侧大脑半球进行检查。根据CT血管成像数据，使用CFD分析评估吻合MCA的STA分支的血流量，即血流速度(FR)。评价血管再通急性期血流动力学变化与血流动力学变化的相关性。结果：术前估计的移植物FR与平均通过时间的变化呈中度相关，与脑血流量和脑血容量的变化呈弱相关。此外，从起点到分叉处，FR与年龄和STA的直径密切相关。结论：通过基于图像的CFD分析获得的术前移植物FR有助于改善血运重建后的平均通过时间。由于移植物的阻力与移植物的直径有关，移植物的大小可能是影响术后血流动力学变化的一个重要因素。这可能会导致对急性剧烈血流动力学变化的风险评估，如脑过度灌流，因此，可能会有更好的手术结果。
Objectives: Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass operation is an effective treatment for patients with Moyamoya disease, and the hemodynamic parameters are reported to be improved after operation. However, there is no report concerning hemodynamic changes from the viewpoint of the preoperative anatomical structure of grafts. In this study, we evaluated the correlation between the preoperatively estimated blood flow of the graft obtained through image-based computational fluid dynamics (CFD) analysis and the hemodynamic changes in the acute phase after revascularization. Materials and methods: A total of 30 hemispheric sides of 23 patients were examined. The blood flow, that is, flow rate (FR) of the STA branches that were anastomosed to the MCA was evaluated using CFD analysis based on computed tomography (CT) angiography imaging data. The correlations between the FR and the hemodynamic changes in the acute phase after revascularization obtained through CT perfusion were assessed. Results: The preoperatively estimated FR of the graft was moderately correlated with the changes in the mean transit time significantly and weakly correlated with those in the cerebral blood flow and cerebral blood volume. In addition, the FR was strongly correlated with age and the diameter of the STA from the origin to the bifurcation. Conclusion: The preoperatively estimated FR of the graft obtained through image-based CFD analysis contributed to the improvement of the mean transit time after revascularization. Because the FR of the graft was associated with the diameter of the STA, the size of the STA might be an important factor in postoperative hemodynamic changes. This might lead to the risk assessment of acute drastic hemodynamic changes as cerebral hyperperfusion, and consequently, better surgical outcomes might be expected.