Introduction: Moyamoya disease (MMD) is a rare cerebrovascular disease associated with cerebral infarction or hemorrhage. Hyperperfusion is the most significant complication of direct bypass surgery. Previous research has shown that an increase in cerebral blood flow (CBF) is strongly related to symptomatic hyperperfusion and highlighted the importance of postoperative assessment of CBF. Objective: The principal aims of this study were to quantitatively analyze the relationship between intraoperative graft flow and increase in CBF and to evaluate the effectiveness of intraoperative graft flow measurement during bypass surgery for patients with MMD. Methods: This study included 91 surgeries in 67 consecutive adult patients with MMD who underwent direct revascularization surgery at our institution between November 2013 and September 2018. Intraoperative graft flow of the branches and main trunk was measured in all patients, after anastomosis had been established. Postoperative CBF measurements were performed under sedation, immediately after surgery. Radiological hyperperfusion was defined as focal high uptake, as determined by CBF imaging immediately after surgery. Patients were divided into two groups (radiological hyperperfusion and nonradiological hyperperfusion groups), and the relationship between intraoperative graft flow and radiological hyperperfusion was analyzed. Results: Significant differences were observed between the radiological hyperperfusion and nonradiological hyperperfusion groups in terms of intraoperative graft flow of both the branch (median 72 vs. 42 mL/min, respectively; p #x3c; 0.01) and main trunk (median 113 vs. 68 mL/min, respectively; p #x3c; 0.01). A receiver-operating characteristic analysis was performed to test the utility of intraoperative flow as a quantitative measure. We set the cutoff values for the intraoperative branch and main trunk flow at 57 mL/min (sensitivity: 0.707, specificity: 0.702; area under the curve [AUC]: 0.773; 95% confidence interval [CI]: 0.675–0.871) and 84 mL/min (sensitivity: 0.667, specificity: 0.771; AUC: 0.78; 95% CI: 0.685–0.875), respectively. Conclusions: Measuring intraoperative graft flow during bypass surgery may be an effective means of predicting hyperperfusion and could serve to facilitate early therapeutic intervention such as strict blood pressure control.
Cerebrovasc Dis Extra 2020;10:66–75

中文翻译：

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术中移植物流量的测量可预测Moyamoya病患者旁路手术期间的放射学高灌注。

简介： Moyamoya病（MMD）是一种罕见的与脑梗塞或出血相关的脑血管疾病。过度灌注是直接搭桥手术最重要的并发症。先前的研究表明，脑血流量（CBF）的增加与症状性过度灌注密切相关，并强调了术后CBF评估的重要性。目的：本研究的主要目的是定量分析MMD患者旁路术中术中移植物流量与CBF增加之间的关系，并评估术中移植物流量测量的有效性。方法：该研究包括2013年11月至2018年9月间在本机构接受直接血管重建手术的67例连续MMD成年患者的91例手术。在建立吻合后，对所有患者的术中移植物的分支和主干流量进行了测量。手术后立即在镇静下进行术后CBF测量。手术后立即通过CBF成像确定放射性高灌注是局灶性高摄取。将患者分为两组（放射线高灌注组和非放射线高灌注组），并分析术中移植物流量与放射线高灌注之间的关系。结果：在分支（分别为中位数72 vs. 42 mL / min；p＃x3c； 0.01）和主干（分别为中位数113 vs. 68 mL）的术中移植物流量方面，放射线高灌注组和非放射线高灌注组之间观察到显着差异。 / min；p＃x3c； 0.01）。进行了接受者操作特征分析，以测试术中血流作为定量指标的效用。我们将术中分支和主干血流的临界值设置为57 mL / min（灵敏度：0.707，特异性：0.702；曲线下面积[AUC]：0.773； 95％置信区间[CI]：0.675-0.871）和分别为84 mL / min（灵敏度：0.667，特异性：0.771； AUC：0.78； 95％CI：0.685–0.875）。结论：在搭桥手术期间测量术中移植物流量可能是预测过度灌注的有效方法，并且可以用于促进早期治疗干预，例如严格控制血压。
Cerebrovasc Dis Extra 2020; 10：66–75