Evaluation value of ultrasound in superficial temporal artery-middle cerebral artery anastomosis in treating moyamoya disease

Abstract:

Objective To conduct the preoperative and postoperative evaluation of moyamoya disease（MMD）patients undergoing superficial temporal artery（STA）-middle cerebral artery（MCA）anastomosis using ultrasound technique，and to investigate the clinical value of ultrasound in early prediction of surgical success rate.Methods A total of 28 patients who underwent STA-MCA anastomosis in The Second Affiliated Hospital of Air Force Medical University from July 2018 to September 2020 were selected. The internal diameters and hemodynamic parameters of main branch，top branch and frontal branch of STA trunk，the distal and proximal MCA and the posterior cerebral artery（PCA） were detected 1-3 days before and 4-7 days after surgery. The internal diameter and hemodynamic parameters of bridging vessels were detected after surgery. Hemodynamic parameters were measured including systolic peak flow velocity（V_s），diastolic end flow velocity（V_d），mean flow velocity（V_m），pulse index（PI） and resistance index（RI）. All patients were divided into two groups according to the results of 6 months to 1 year digital saubtraction angiograph（DSA）examination after surgery，and the differences between the two groups were statistically analyzed.Results All patients underwent DSA examination within 6 months to 1 year after surgery，which confirmed that 86%（24/28）of the anastomosis vessels were patency，and the operation was successful. Compared with preoperation，92%（22/24）of patients in the patency group showed the diameter of STA and bridge vascular was significantly widened，the V_s，V_m and V_d were significantly increased，PI value was significantly decreased after surgery，“intracranial arterialization” change appeared in spectrum，and reverse flow occurred in MCA distal segment（all P<0.05）. There were no statistically significant differences in the proximal segment of MCA and PCA blood flow parameters before and after surgery. The diameter of STA and bridge vascular in the patency group was significantly wider than that in the non-patency group（P<0.05）. The V_s，V_m and V_d values of STA and bridging vascular in the patency group were higher than those in non-patency group，and the PI value was lower than that in the non-patency group，with significant differences between the two groups（P<0.05）. ROC curve were showed that the change rate of STA diameter after surgery was greater than or equal to 37%，and the STA-PI value was less than or equal to 1.26，which were the best cut-off values to predict the success of surgery.Conclusion When MMD patients are undergoing STA-MCA anastomosis surgery，ultrasound technology can beused to detect the internal diameters and blood flow parameters of STA before surgery，and the internal diameter change rate and the PI of STA and bridge vessels after surgery，which has potential clinical application value for early prediction of whether the anastomotic vessels are patency and whether the operation is successful.