Ultrasonographic assessment of bypass capacity after revascularization surgery in moyamoya disease: a systematic review and single-arm meta-analysis

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2025-09-10 DOI:10.1007/s00701-025-06658-6

Natalia Anna Koc, Maurycy Rakowski MD, Samuel D. Pettersson, Paulina Skrzypkowska MD, Tomasz Szmuda MD, PhD, Piotr Zieliński MD, PhD

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Abstract

Purpose

Moyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive arterial stenosis and fragile collateral formation, elevating stroke risk. Revascularization is the standard treatment, yet up to 27% of patients experience ischemic events within a year due to bypass insufficiency. While digital subtraction angiography (DSA) remains the gold standard for assessing bypass function, it is invasive and time-consuming. This study evaluates ultrasonography (US) as a noninvasive, cost-effective tool to assess bypass capacity post-revascularization in MMD.

Methods

A systematic search was conducted following PRISMA guidelines. PubMed, Web of Science, and Scopus were searched for studies reporting US parameters with control imaging confirming bypass capacity. Study quality was assessed using the Newcastle–Ottawa Scale. Mean difference (MD) values were calculated using random-effects models. High bypass capacity was defined as good patency or favorable collateral development.

Results

Eight cohort studies comprising 264 MMD patients and 301 operated hemispheres were included, with 180 demonstrating high bypass capacity. Within two weeks post-surgery, increased superficial temporal artery (STA) peak systolic velocity (PSV, MD = 28.26, p < 0.0001), mean flow velocity (MFV, MD = 22.97, p = 0.03), end-diastolic velocity (EDV, MD = 33.45, p < 0.0001), and decreased resistance index (RI, MD = –0.09, p = 0.006) were predictive. External carotid artery (ECA) EDV (MD = 13.92, p = 0.04) was also significant. At 3–6 months, elevated EDV in both STA (MD = 8.13, p = 0.006) and ECA (MD = 8.71, p = 0.0002) remained predictive. In the indirect subgroup, lower anterior cerebral artery (ACA) MFV within 0–3 months predicted favorable outcomes (MD = –64.98, p = 0.001).

Conclusions

Changes in STA and ECA US parameters measured following revascularization surgery predict high bypass capacity. Decreased ACA MFV suggests effective revascularization after indirect surgery. Ultrasound modality offers a valuable, noninvasive tool for postoperative assessment in MMD.

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烟雾病血运重建术后超声评估旁路容量：系统回顾和单臂荟萃分析

烟雾病（MMD）是一种慢性脑血管疾病，以进行性动脉狭窄和脆弱侧支形成为特征，增加卒中风险。血运重建术是标准的治疗方法，但高达27%的患者在一年内由于旁路功能不全而发生缺血事件。虽然数字减影血管造影（DSA）仍然是评估旁路功能的金标准，但它是有创的且耗时的。本研究评估了超声（US）作为一种无创、经济有效的工具来评估烟雾病血运重建后的旁路容量。方法按照PRISMA指南进行系统检索。检索PubMed、Web of Science和Scopus，查找报告US参数与对照成像确认旁路容量的研究。使用纽卡斯尔-渥太华量表评估研究质量。采用随机效应模型计算均差（MD）值。高旁路容量被定义为良好的通畅或有利的侧支发展。结果纳入8项队列研究，包括264例烟雾病患者和301例手术半球，其中180例显示高旁路容量。术后2周内，颞浅动脉（STA）峰值收缩速度升高（PSV, MD = 28.26, p < 0.0001）、平均血流速度（MFV, MD = 22.97, p = 0.03）、舒张末期速度（EDV, MD = 33.45, p < 0.0001）、阻力指数下降（RI, MD = -0.09, p = 0.006）具有预测意义。颈外动脉（ECA） EDV （MD = 13.92, p = 0.04）也有显著性差异。在3-6个月时，STA （MD = 8.13, p = 0.006）和ECA （MD = 8.71, p = 0.0002）的EDV升高仍然具有预测意义。在间接亚组中，0-3个月内的大脑前动脉（ACA） MFV预测了良好的结果（MD = -64.98, p = 0.001）。结论血运重建术后STA和ECA US参数的变化预示着高旁路容量。降低ACA MFV提示间接手术后有效的血运重建。超声模式为烟雾病术后评估提供了一种有价值的、无创的工具。

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

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.