Scholarlink

Purpose <p>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.</p> Methods <p>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.</p> Results <p>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, <i>p</i> &lt; 0.0001), mean flow velocity (MFV, MD = 22.97, <i>p</i> = 0.03), end-diastolic velocity (EDV, MD = 33.45, <i>p</i> &lt; 0.0001), and decreased resistance index (RI, MD = –0.09, <i>p</i> = 0.006) were predictive. External carotid artery (ECA) EDV (MD = 13.92, <i>p</i> = 0.04) was also significant. At 3–6&#xa0;months, elevated EDV in both STA (MD = 8.13, <i>p</i> = 0.006) and ECA (MD = 8.71, <i>p</i> = 0.0002) remained predictive. In the indirect subgroup, lower anterior cerebral artery (ACA) MFV within 0–3&#xa0;months predicted favorable outcomes (MD = –64.98, <i>p</i> = 0.001).</p> Conclusions <p>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.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

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

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年9月10日

查看全文
  • Natalia Anna Koc,
  • Maurycy Rakowski,
  • Samuel D. Pettersson,
  • Paulina Skrzypkowska,
  • Tomasz Szmuda,
  • Piotr Zieliński

摘要

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.