scholarly journals Low flow velocity in the middle cerebral artery predicting infarction after bypass surgery in adult moyamoya disease

2017 ◽  
Vol 126 (5) ◽  
pp. 1573-1577 ◽  
Author(s):  
Hoyeon Cho ◽  
Kyung Il Jo ◽  
Jua Yu ◽  
Je Young Yeon ◽  
Seung-Chyul Hong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Early Stage ◽  
Low Flow ◽  
Mean Flow ◽  
Postoperative Mri

OBJECTIVEDirect and indirect bypass surgeries are recognized as the most effective treatments for preventing further stroke in adults with moyamoya disease (MMD). However, the risk factors for postoperative infarction after bypass surgery for MMD are not well established. Therefore, the objective of this study was to investigate the risk factors for postoperative infarction. In particular, the authors sought to determine whether transcranial Doppler (TCD) ultrasonography measurements of mean flow velocity (MFV) in the middle cerebral artery (MCA) could predict postrevascularization infarction.METHODSThe medical records of patients with MMD who underwent direct bypass surgery at the authors' institution between July 2012 and April 2015 were reviewed. The MFV in the MCA was measured with TCD ultrasonography and categorized as high (> 80 cm/sec), medium (40–80 cm/sec), and low (< 40 cm/sec). Postoperative MRI, including diffusion-weighted imaging, was performed for all patients within a week of their surgery. Angiographic findings were classified according to the Suzuki scale. Postrevascularization infarction was defined as any diffusion restriction on postoperative MRI scans. Postoperative neurological status was assessed through a clinical chart review, and the modified Rankin Scale was used to evaluate clinical outcomes.RESULTSOf 43 hemispheres in which bypass surgery for MMD was performed, 11 showed postrevascularization infarction. Ten of these hemispheres had low MFV and 1 had medium MFV in the ipsilateral MCA. In both univariate and multivariate analyses, a low MFV was associated with postrevascularization infarction (adjusted OR 109.2, 95% CI 1.9–6245.3). A low MFV was also statistically significantly associated with more advanced MMD stage (p = 0.02).CONCLUSIONSA low MFV in the ipsilateral MCA may predict postrevascularization infarction. Bypass surgery for MMD appears to be safe in early-stage MMD. Results of TCD ultrasonography provide clinical data on the hemodynamics in MMD patients before and after revascularization.

Abstract TP132: The Clinical Role of Microembolic Signals in Adult Moyamoya Disease

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Chiman Jeon ◽  
Kyung-Il Jo ◽  
Seung-Chyul Hong ◽  
Jong-Soo Kim
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Early Stage ◽  
Hazard Ratio ◽  
Controlled Study ◽  
Mean Flow ◽  
Ischemic Event ◽  
Artery Embolism

Background: Both hemodynamic compromise and artery-to-artery embolism have been thought to be implicated in moyamoya disease (MMD) with ischemic symptoms. The relationship between microembolic signals (MESs) and ischemic stroke remains to be clarified. We aimed to identify associated risk factors of MESs and to explore clinical significance of MESs in adult MMD with ischemic stroke. Methods: A total of 48 patients (89 hemispheres) newly diagnosed with adult MMD were enrolled and angiographically classified according to the Suzuki staging system. For detection of MESs, transcranial doppler (TCD) monitoring was performed within 2 days after first admission. Recent ischemic events, including transient ischemic attack (TIA), which occurred within 3 months of diagnosis, were also recorded. Mean flow velocities in middle cerebral artery using TCD were also evaluated. Results: Eleven hemispheres were found to have MESs, and 78 had no MESs. Among clinical types of MMD in 89 hemispheres, ischemic-type MMD (n = 42, 47%) was most common. Antiplatelet agents were prescribed for 22 patients (43 hemispheres) before evaluation for MES. The incidence of recent ischemic event was associated with the MES status (P = 0.024). Recent ischemic event was found to be predictive of MESs in adult MMD (hazard ratio: 6.294; 95% CI 1.345-29.46). Detection of MESs was significantly higher in the high mean flow velocity of the middle cerebral artery (P = 0.019). After controlling for age, sex, recent ischemic event, and antiplatelets, ‘early stage’ MMD (Suzuki stage I and II) was the independent predictor of MESs at baseline (hazard ratio: 6.172; 95% CI 1.235-31.25). Conclusions: MESs, known to be indicative of artery-to-artery embolism in steno-occlusive cerebrovascular diseases, were observed in ‘early stage’ MMD, particularly with high MFVs and clinically associated with recent ischemic stroke. This necessitates the need for the efficacy of antiplatelets in the treatment of adult MMD with ischemic stroke in a prospective controlled study in the future.

scholarly journals Risk Factors for Delayed Neurocognitive Recovery According to Brain Biomarkers and Cerebral Blood Flow Velocity

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 288
Author(s):  
Rasa Bukauskienė ◽  
Edmundas Širvinskas ◽  
Tadas Lenkutis ◽  
Rimantas Benetis ◽  
Rasa Steponavičiūtė
Keyword(s):  
Risk Factors ◽  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Co2 Concentration ◽  
Anesthesia Induction ◽  
Neurocognitive Evaluation

Background and Objectives: The aim of this study is to identify risk factors for the development of delayed neurocognitive recovery (dNCR). Materials and Methods: 140 patients underwent neurocognitive evaluations (Adenbrooke, MoCa, trial making, and CAM test) and middle cerebral artery (MCA) blood flow velocity (BFV) measurements, one day before cardiac surgery. BFV was re-evaluated after anesthesia induction, before the beginning, middle, end, and after cardiopulmonary bypass (CPB) and postsurgery. To measure glial fibrillary acidic protein (GFAP) and neurofilament heavy chain (Nf-H), blood samples were collected after anesthesia induction, 24 and 48 h after the surgery. Neurocognitive evaluation was repeated 7–10 days after surgery. According to the results, patients were divided into two groups: with dNCR (dNCR group) and without dNCR (non-dNCR group). Results: 101 patients completed participation in this research. GFAP increased in both the non-dNCR group (p < 0.01) and in the dNCR group (p < 0.01), but there was no difference between the groups (after 24 h, p 0.342; after 48 h, p 0.273). Nf-H increased in both groups (p < 0.01), but there was no difference between them (after 24 h, p = 0.240; after 48 h, p = 0.597). MCA BFV was significantly lower in the dNCR group during the bypass (37.13 cm/s SD 7.70 versus 43.40 cm/s SD 9.56; p = 0.001) and after surgery (40.54 cm/s SD 11.21 versus 47.6 cm/s SD 12.01; p = 0.003). Results of neurocognitive tests correlated with CO2 concentration (Pearson’s r 0.40, p < 0.01), hematocrit (r 0.42, p < 0.01), MCA BFV during bypass (r 0.41, p < 0.01), and age (r −0.533, p < 0.01). The probability of developing dNCR increases 1.21 times with every one year of increased age (p < 0.01). The probability of developing dNCR increases 1.07 times with a decrease of BFV within 1 cm/s during bypass (p = 0.02). Conclusion: Risk factors contributing to dNCR among the tested patients were older age and middle cerebral artery blood flow velocity decrease during bypass.

Influence of posture on middle cerebral artery mean flow velocity in humans

1995 ◽  
Vol 71 (2-3) ◽  
pp. 161-165 ◽  
Author(s):  
E. Savin ◽  
O. Bailliart ◽  
A. Checoury ◽  
P. Bonnin ◽  
C. Grossin ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Mean Flow ◽  
Mean Flow Velocity

37: MEAN FLOW VELOCITY OF THE MIDDLE CEREBRAL ARTERY PREDICTS POOR OUTCOME AFTER SUBARACHNOID HEMORRHAGE

2020 ◽  
Vol 48 (1) ◽  
pp. 19-19
Author(s):  
Khalil Yousef ◽  
Elizabeth Crago ◽  
Anne Fisher ◽  
Theodore Lagattuta ◽  
Marilyn Hravnak
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Mean Flow ◽  
Poor Outcome ◽  
Mean Flow Velocity

scholarly journals Moyamoya Disease Superficial Temporal Artery-to-Middle Cerebral Artery Onlay: 2-Dimensional Operative Video

2020 ◽  
Vol 18 (6) ◽  
pp. E229-E229
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Video Recording ◽  
Temporal Artery ◽  
Low Flow ◽  
Institutional Review ◽  
Direct Anastomosis

Abstract The most frequently performed low-flow bypass procedure is the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass. If available, a suitable M2 or M3 cortical branch is anastomosed to the donor vessel. This patient had severe moyamoya disease with an ipsilateral perfusion deficit and transient ischemic attacks. Given the need for revascularization, an STA-to-MCA bypass was performed. There was no suitable recipient M3 branch for direct anastomosis, and therefore an indirect bypass was performed by onlaying the STA onto the cortical surface and suturing the adventitia of the STA to the arachnoid of the underlying cortex. The dural leaflets were then inverted to potentiate further revascularization of the underlying cortex. The patient remained at their neurological baseline and demonstrated an enhanced perfusion of the ipsilateral MCA territory on follow-up evaluation. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Clinical implications of the cortical hyperintensity belt sign in fluid-attenuated inversion recovery images after bypass surgery for moyamoya disease

2017 ◽  
Vol 126 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Eika Hamano ◽  
Hiroharu Kataoka ◽  
Naomi Morita ◽  
Daisuke Maruyama ◽  
Tetsu Satow ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Vasogenic Edema ◽  
Posterior Part ◽  
The Other ◽  
Neurological Deficits ◽  
Other Hand ◽  
Direct Bypass

OBJECTIVE Transient neurological symptoms are frequently observed during the early postoperative period after direct bypass surgery for moyamoya disease. Abnormal signal changes in the cerebral cortex can be seen in postoperative MR images. The purpose of this study was to reveal the radiological features of the “cortical hyperintensity belt (CHB) sign” in postoperative FLAIR images and to verify its relationship to transient neurological events (TNEs) and regional cerebral blood flow (rCBF). METHODS A total of 141 hemispheres in 107 consecutive patients with moyamoya disease who had undergone direct bypass surgery were analyzed. In all cases, FLAIR images were obtained during postoperative days (PODs) 1–3 and during the chronic period (3.2 ± 1.13 months after surgery). The CHB sign was defined as an intraparenchymal high-intensity signal within the cortex of the surgically treated hemisphere with no infarction or hemorrhage present. The territory of the middle cerebral artery was divided into anterior and posterior parts, with the extent of the CHB sign in each part scored as 0 for none; 1 for presence in less than half of the part; and 2 for presence in more than half of the part. The sum of these scores provided the CHB score (0–4). TNEs were defined as reversible neurological deficits detected both objectively and subjectively. The rCBF was measured with SPECT using N-isopropyl-p-[123I]iodoamphetamine before surgery and during PODs 1–3. The rCBF increase ratio was calculated by comparing the pre- and postoperative count activity. RESULTS Cortical hyperintensity belt signs were detected in 112 cases (79.4%) and all disappeared during the chronic period. Although all bypass grafts were anastomosed to the anterior part of the middle cerebral artery territory, CHB signs were much more pronounced in the posterior part (p < 0.0001). TNEs were observed in 86 cases (61.0%). Patients with TNEs showed significantly higher CHB scores than those without (2.31 ± 0.13 vs 1.24 ± 0.16, p < 0.0001). The CHB score, on the other hand, showed no relationship with the rCBF increase ratio (p = 0.775). In addition, the rCBF increase ratio did not differ between those patients with TNEs and those without (1.15 ± 0.033 vs 1.16 ± 0.037, p = 0.978). CONCLUSIONS The findings strongly suggest that the presence of the CHB sign during PODs 1–3 can be a predictor of TNEs after bypass surgery for moyamoya disease. On the other hand, presence of this sign appears to have no direct relationship with the postoperative local hyperperfusion phenomenon. Vasogenic edema can be hypothesized as the pathophysiology of the CHB sign, because the sign was transient and never accompanied by infarction in the present series.

scholarly journals Cerebral haemodynamics in early puerperium: A prospective study

Ultrasound ◽  
2017 ◽  
Vol 25 (2) ◽  
pp. 107-114 ◽  
Author(s):  
GP Anzola ◽  
R Brighenti ◽  
M Cobelli ◽  
A Giossi ◽  
S Mazzucco ◽  
...  
Keyword(s):  
Prospective Study ◽  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Cerebral Arteries ◽  
Velocity Ratio ◽  
Mean Flow ◽  
Middle Cerebral Arteries ◽  
A Prospective Study ◽  
Mean Flow Velocity

Aim Prospective study on 900 consecutive puerperae to assess normal values and range of the blood flow velocity in the middle cerebral artery in both hemispheres. Material and method M1 and M2 segments of both middle cerebral arteries were assessed in all subjects within 96 hours of delivery. Mean flow velocity was recorded after adjusting for insonation angle. Lindegaard index (LI = middle cerebral artery–Internal Carotid Artery mean flow velocity ratio) was calculated whenever the mean flow velocity exceeded 100 cm/second. Asymmetry indexes were calculated inter hemispherically for M1 and M2 segments separately. Results Mean flow velocities were 74 ± 17 and 72 ± 17 in right and 73 ± 17 and 72 ± 17 cm/second in the left M1 and M2, respectively. A total of 136 subjects (12.1%) exceeded the threshold of 100 cm/second, but LI was consistently <3 in all of them. Mean flow velocity was inversely and independently correlated to haemoglobin levels and to parity. Mean asymmetry indexes were 0.25 ± 23 in M1 and 0.45 ± 25 in M2. Conclusion Mean flow velocity in the middle cerebral artery of healthy subjects in early puerperium is higher than in age-matched non-puerperal women and may exceed the threshold of 100 cm/second with no evidence of intracranial spasm, because of blood loss during delivery. Mean flow velocity is independently correlated with parity. Right-to-left mean flow velocity asymmetry may reach 50% as a consequence of a transient imbalance in vascular tone regulation.

Can Combined Bypass Surgery at Middle Cerebral Artery Territory Save Anterior Cerebral Artery Territory in Adult Moyamoya Disease?

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 431-438 ◽  
Author(s):  
Won-Sang Cho ◽  
Jeong Eun Kim ◽  
Jin Chul Paeng ◽  
Minseok Suh ◽  
Yong-il Kim ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Anterior Cerebral Artery ◽  
Middle Cerebral Artery Territory ◽  
Reservoir Capacity ◽  
Hemodynamic Changes ◽  
Adult Moyamoya Disease

Abstract BACKGROUND: Patients with moyamoya disease are frequently encountered with improved symptoms related to anterior cerebral artery territory (ACAt) and middle cerebral artery territory (MCAt) after bypass surgery at MCAt. OBJECTIVE: To evaluate hemodynamic changes in MCAt and ACAt after bypass surgery in adult moyamoya disease. METHODS: Combined bypass surgery was performed on 140 hemispheres in 126 patients with MCAt symptoms. Among them, 87 hemispheres (62.1%) accompanied preoperative ACAt symptoms. Clinical, hemodynamic, and angiographic states were evaluated preoperatively and approximately 6 months after surgery. RESULTS: Preoperative symptoms resolved in 127 MCAt (90.7%) and 82 ACAt (94.3%). Hemodynamic analysis of total patients showed a significant improvement in MCAt basal perfusion and reservoir capacity (P &lt; .001 and P = .002, respectively) and ACAt basal perfusion (P = .001). In a subgroup analysis, 82 hemispheres that completely recovered from preoperative ACAt symptoms showed a significant improvement in MCAt basal perfusion and reservoir capacity (P &lt; .001 and P = .05, respectively) and ACAt basal perfusion (P = .04). Meanwhile, 53 hemispheres that had never experienced ACAt symptoms significantly improved MCAt basal perfusion and reservoir capacity (P &lt; .001 and P = .05, respectively); however, no ACAt changes were observed. A qualitative angiographic analysis demonstrated a higher trend of leptomeningeal formation from MCAt to ACAt in the former subgroup (P = .05). During follow-up, no ACAt infarctions were observed. CONCLUSION: Combined bypass surgery at MCAt resulted in hemodynamic improvements in ACAt and MCAt, especially in patients with preoperative ACAt symptoms.

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