Indocyanine green videoangiography for assessment of postoperative hyperperfusion in moyamoya disease
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Nobutaka Horie1, Yuhtaka Fukuda, Tsuyoshi Izumo
1Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan, nobstanford@gmail.com.
Background:
Postoperative cerebral hyperperfusion (HP) is a notable complication that occurs more frequently in moyamoya disease (MMD) than in atherosclerosis. This study aimed to clarify the characteristics of intraoperative indocyanine green (ICG) videoangiography in MMD and atherosclerotic disease in terms of postoperative HP.
Methods:
This prospective study included 47 patients with 60 sides that underwent superior temporal artery (STA)-middle cerebral artery (MCA) single bypass. ICG videoangiography was performed after revascularization. The ICG time intensity curve was recorded in the STA, proximal MCA, distal MCA, and superficial Sylvian vein, and the angiographic differences among adult MMD, pediatric MMD, and atherosclerosis were analyzed.
Results:
Twenty-two patients (27 sides) had adult MMD, 14 patients (22 sides) had pediatric MMD, and 11 patients (11 sides) had atherosclerosis. Postoperative HP was significantly higher in adult MMD (40.7 %) than in pediatric MMD (18.2 %) and atherosclerosis (0 %). Adult MMD with HP was associated with a longer ICG peak time (P < 0.001). There was no correlation between the ICG peak time and preoperative cerebral blood flow or vascular reserve. The ratio of the vessel caliber was also higher in adult MMD with HP (P < 0.001).
Conclusions:
ICG videoangiography provides different characteristics of bypass flow among adult MMD, pediatric MMD, and atherosclerosis. Poor run-off and stagnation of blood flow from the STA might contribute to postoperative HP in MMD. The occurrence of postoperative HP in MMD could depend on two factors: donor STA size and poor run-off and integrity of the blood brain barrier in the recipient MCA.
Insights
Postoperative cerebral hyperperfusion (HP) is more common in adult moyamoya disease (MMD) after bypass surgery. Indocyanine green (ICG) videoangiography revealed longer ICG peak times and larger vessel caliber in adult MMD patients experiencing HP.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Diagnostic Imaging
Background:
- Postoperative cerebral hyperperfusion (HP) is a significant complication following revascularization surgery.
- Moyamoya disease (MMD) exhibits a higher incidence of HP compared to atherosclerotic cerebrovascular disease.
Purpose of the Study:
- To investigate the distinct characteristics of intraoperative indocyanine green (ICG) videoangiography in Moyamoya disease (MMD) and atherosclerotic disease.
- To correlate ICG findings with the occurrence of postoperative cerebral hyperperfusion (HP).
Main Methods:
- Prospective study of 47 patients undergoing superior temporal artery (STA)-middle cerebral artery (MCA) single bypass.
- Intraoperative ICG videoangiography with time-intensity curve analysis in STA, MCA, and Sylvian vein.
- Comparison of angiographic parameters among adult MMD, pediatric MMD, and atherosclerosis groups.
Main Results:
- Adult MMD showed a significantly higher HP rate (40.7%) compared to pediatric MMD (18.2%) and atherosclerosis (0%).
- Adult MMD with HP was associated with longer ICG peak times and larger vessel caliber ratios.
- No correlation was found between ICG peak time and preoperative cerebral blood flow or vascular reserve.
Conclusions:
- ICG videoangiography differentiates bypass flow characteristics across adult MMD, pediatric MMD, and atherosclerosis.
- Poor blood flow runoff and stagnation from the STA may contribute to HP in MMD.
- Postoperative HP in MMD is influenced by donor STA size, poor runoff, and recipient MCA blood-brain barrier integrity.
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