Combined CTP and QDSA Assessment Predicts Postoperative Cerebral Hyperperfusion Syndrome in Moyamoya Disease

To evaluate the predictive value of combined computed tomography perfusion (CTP) and quantitative digital subtraction angiography (QDSA) for cerebral hyperperfusion syndrome (CHS) after surgical revascularization in moyamoya disease (MMD).

This retrospective study included 340 patients (396 hemispheres) with MMD who underwent direct or combined bypass surgery. Preoperative CTP and QDSA assessments were performed to assess cerebral perfusion and analyze hemodynamic parameters. Logistic regression with generalized estimating equations (GEE), accounting for within-patient clustering, and receiver operating characteristic (ROC) analyses were used to identify risk factors and evaluate predictive performance.

Postoperative CHS occurred in 29.04% (115/396) of hemispheres. Independent risk factors included CTP stages 3-4 (OR 7.40, 95% CI 4.27-12.84, p<0.001), shortened TTP of superficial temporal artery (OR 0.66, 95% CI 0.55-0.79, p<0.001), older age (OR 1.03, 95% CI 1.00-1.06, p=0.030), and hypertension (OR 4.74, 95% CI 2.74-8.19, p<0.001). The multivariate integrated model demonstrated good predictive performance (AUC 0.815, 95% CI 0.771-0.858).

Combined CTP and QDSA assessment effectively predicts CHS risk after MMD revascularization, with CTP stages 3-4, shortened TTP of STA, older age, and hypertension as independent risk factors. This dual-modality approach aids in preoperative risk stratification and surgical planning.