| Objective:Moyamoya disease(MMD)is a slow,progressive steno-occlusive disease arising in the terminal portions of the cerebral internal carotid artery(ICA).The internal carotid artery stenosis or occlusion can lead to reduced blood perfusion of the brain,contributing to clinical symptoms.Brain blood supply is via two pairs of arteries:right and left common carotid arteries and right and left vertebral arteries.Although PC A have been found play an important role in patients with moyamoya disease,most of these studies however do not specifically demonstrate a role for PC A in MMD.The purpose of this study was to explore the role for PCA in smoke-like abnormal blood vessels.Combining DSA and cerebral perfusion before and after surgical,to provide a new compensatory grading method for posterior circulation in moyamoya disease.And to explore its correlation with anterior cerebral circulation,surgical efficacy and cerebral perfusion.Aiming to further improve the preoperative evaluation of patients with MMD.Methods:1.This study is a retrospective study.Retrospective analysis of adult cases of moyamoya disease diagnosed by DSA of our hospital from October 1,2019 to April 30,2021.Inclusion criteria:①Adult patients(≥18 years old)who were diagnosed with moyamoya disease by DSA in our hospital;②All patients underwent DSA and whole cerebral arterial spin labeling(ASL)examination before surgery;③The first surgical treatment was performed in our hospital.The surgery were STA-MCA+ED AS.And the vascular bypass anastomosis was successful,and the intraoperative angiography showed patency during surgery;④ The DSA and ASL examinations were re-examined 3 months after the operation.Exclusion criteria:①anatomical variation of vertebrobasilar artery system and internal carotid artery system;② acute or subacute cerebral infarction and cerebral hemorrhage during perioperative period.The posterior circulation compensatory grading is based on the center of the midbrain in the sagittal plane,and the cerebral hemisphere is divided into three equal parts by making rays through the junction of the genus of the corpus callosum and the body of the corpus callosum,and the junction of the body of the corpus callosum and the spleen of the corpus callosum.According to the area that the DSA image VA of patients with moyamoya disease can reach from back to front,it is defined as 0,1,2,and 3 grades,and assigned as 0,1,2,and 3 points respectively.To explore the correlation between the posterior circulation compensation grading and Suzuki stage.Matsushima grading and cerebral perfusion level.According to the results,the relationship between the posterior circulation compensation grading and the anterior circulation,surgical efficacy and perfusion improvement was preliminarily analyzed.2.The anterior cerebral circulation is represented by the classic Suzuki staging.The staging criteria are as follows:Stage 1:Stenosis at the bifurcation of the internal carotid artery,no other abnormal findings;Stage 2:Stenosis at the bifurcation of the internal carotid artery,smoke at the base of the skull Vascularization,dilation of branches of the anterior cerebral artery(ACA)and middle cerebral artery(MCA),no extracranial to intracranial collateral circulation yet;stage 3:the main branches of ACA and MCA are missing,the moyamoya vessels are very obvious,and the formation of moyamoya vascular mass,each artery that forms the moyamoya mass cannot be identified on angiography,the PCA or the posterior communicating artery is not affected,and there is no extracranial to intracranial collateral circulation;stage 4:moyamoya vessels begin to decrease,from the cranial Lateral to intracranial collateral circulation gradually formed;stage 5:all major arteries from the ICA disappeared completely,the moyamoya vessels were less than in stage 4,and the collateral blood supply from extracranial to intracranial was further increased;stage 6:moyamoya vessels Completely disappeared,only the collateral circulation from the extracranial to the intracranial was seen.During this period,the blood supply of ICA to the brain has completely disappeared,and the cerebral circulation supply completely depends on the external carotid artery or vertebral artery.Suzuki staging 1-6 is assigned as 1-6 points respectively.3.Postoperative surgical efficacy is represented by the Matsushima grading,which is graded as follows:A grade:the postoperative bypass vascular perfusion area is greater than 2/3 of the MCA perfusion area;B grade:the postoperative bypass vascular perfusion area is within 1/3-2/1 of the MCA perfusion area Between 3 and 3;grade C:The perfusion area of the bypass vessel after surgery is less than 1/3 of the MCA perfusion area.Grades A,B,and C are assigned 3,2,and 1 points,respectively.4.The perfusion level of the cerebral hemisphere was assessed by whole cerebral arterial spin labeling(ASL).Preoperative Suzuki staging,preoperative and postoperative circulatory compensation grading,preoperative cerebral cerebral blood flow(ASL-CBF),postoperative Matsushima grading,postoperative ASL-CBF,and perfusion difference(operative Post-ASL-CBF-Pre-operative ASL-CBF).5.Statistical data were analyzed by SPSS 24.0 software.Spearman correlation analysis was used.The correlation between posterior circulation compensation grade and Suzuki stage,Matsushima grade and cerebral perfusion was analyzed.If P<0.05,the difference is considered to be statistically significant,and there is a correlation between the variables.On the contrary,when P>0.05,there is no correlation between the two variables.Results:A total of 55 patients with moyamoya disease with 55 sides were included,including 47(85.5%)patients with ischemic type and 8(14.5%)patients with hemorrhagic type,all of whom underwent STA-MCA+EDAS.The mean age was 46.3(46.3±8.2)years.The mean follow-up time was 5.2(5.2±1.7)months.The Suzuki staging averages 4.0 points.The post-circulation compensation grade averaged 1.9 points.The average postoperative Songdo grading was 1.7 points.The average preoperative ASL-CBF perfusion was 25.65±12.70ml/min/100g.The average perfusion of ASL-CBF after operation was 33.44±8.47ml/min/100g.There was a positive correlation between the posterior circulation compensatory classification and Suzuki staging,and the correlation coefficient was r=0.502,P<0.01.There was no significant correlation between the posterior circulation compensation classification and postoperative Songdo classification,P=0.19;there was no significant correlation between the posterior circulation compensation classification and the poor ASL perfusion,P=0.651.However,we found that the posterior circulation compensatory classification was positively correlated with the preoperative ASL-CBF,and the correlation coefficient was r=0.337,P<0.05.Conclusions:When this classification is used for posterior circulation compensation in moyamoya disease patients,it is correlated with Suzuki staging and positively correlated with preoperative perfusion level,which may have clinical utility and may be helpful for better preoperative assessment. |
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