The Role of TCD in Assessing Postoperative Collateral Development and Long-Term Clinical Outcome in Moyamoya Disease

IF 4.8 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2025-03-18 DOI:10.1111/cns.70245

Shuangfeng Huang, Songtao Pei, Yiqin Han, Jiali Xu, Lanjing Wang, Heguan Fu, Changhong Ren, Xunming Ji, Sijie Li, Cong Han

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Abstract

Aims

To explore the role of transcranial Doppler (TCD) parameters after encephaloduroarteriosynangiosis (EDAS) to identify collateral development in moyamoya disease (MMD) and assess the relationship between these collateral formations and long-term postoperative cerebrovascular events.

Methods

A retrospective analysis of 91 MMD patients who underwent EDAS. Patients were categorized into rich or poor collateral groups based on postoperative angiography. TCD was used to monitor changes in hemodynamic parameters pre-and post-surgery. The association between clinical outcome, TCD parameters, and the degree of collateral development was investigated.

Outcomes

Ninety-one patients were assessed, with 45 (49.0%) exhibiting rich collaterals and 46 (51.0%) showing poor collaterals. Over 2 years, the rich collateral group experienced significantly fewer cerebrovascular events than the poor collateral group (p = 0.041). Postoperative evaluations demonstrated significant improvements in hemodynamic parameters within the rich collateral group, including increases in peak-systolic velocity (PSV), end-diastolic velocity (EDV), and mean velocity (MV), alongside decreases in resistance index (RI) and pulsatility index (PI) (p < 0.05). An EDV cutoff of > 16.62 cm/s in the superficial temporal artery (STA) effectively identified collateral development, yielding an area under the curve (AUC) of 0.907. Additionally, multivariate analysis revealed a strong association between preoperative MV of the STA and collateral formation.

Conclusion

TCD sonography is a non-invasive modality essential for assessing cerebral hemodynamics after revascularization in MMD. Collateral development shown on angiography corresponds to hemodynamic changes reflected in TCD. The postoperative EDV of the STA was a vital indicator of effective collaterals. Patients with well-developed collaterals were at a lower risk of long-term cerebrovascular events post-surgery.

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TCD在烟雾病术后侧枝发育和长期临床预后评估中的作用

目的探讨脑硬动脉合并病（EDAS）后经颅多普勒（TCD）参数在识别烟雾病（MMD）侧支形成中的作用，并评估这些侧支形成与术后长期脑血管事件的关系。方法回顾性分析91例烟雾病患者行EDAS的临床资料。根据术后血管造影将患者分为丰富侧支组和贫乏侧支组。TCD用于监测手术前后血流动力学参数的变化。研究临床结果、TCD参数与侧支发展程度之间的关系。结果91例患者被评估，其中45例（49.0%）表现为丰富络，46例（51.0%）表现为不良络。2年后，丰富侧支组脑血管事件明显少于贫乏侧支组（p = 0.041）。术后评估显示丰富侧支组的血流动力学参数有显著改善，包括峰值收缩速度（PSV）、舒张末期速度（EDV）和平均速度（MV）的增加，以及阻力指数（RI）和脉搏指数（PI）的降低（p < 0.05）。颞浅动脉（STA）的EDV截止速度为16.62 cm/s，有效识别侧支发育，曲线下面积（AUC）为0.907。此外，多变量分析显示术前STA的MV与侧支形成有很强的相关性。结论TCD超声是评估烟雾病血运重建术后脑血流动力学的一种无创方法。血管造影显示的侧枝发育与TCD所反映的血流动力学变化相对应。STA术后EDV是判断有效侧支的重要指标。侧支发达的患者术后发生长期脑血管事件的风险较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.