Objective For patients with moyamoya disease (MMD) and atherosclerosis cerebrovascular disease (ACVD), we used intraoperative indocyanine green (ICG) angiography with Flow 800 software to analyze the hemodynamic feature and changes of the regional cortex in superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery. Compared with normal control group, to explore the hemodynamics of the cortex and whether the STA-MCA bypass surgery can improve the regional cortex blood flow.
Methods Thirty-four patients with MMD or ACVD admitted to the Third Department of Cerebralvascular Disease of Beijing Tiantan Hospital between April 2013 and September 2014 were retrospectively analyzed. All patients underwent STA-MCA bypass surgery. Cortical ICG angiography data before and after bypass surgery were recorded by intraoperative ICG angiography technique. Thirteen patients with no cerebrovascular stenosis or occlusion were selected as control group. Cortical hemodynamic features were compared among the three groups. The following hemodynamic parameters were assessed via analyzing the ICG transit curves of fluorescence intensities in interest vessels (cortical artery, vein, receptor artery, receptor arterial branches, adjacent cortical arteries, remote cortical arteries):maximum intensity, slope of ICG curve, time to half-maximal fluorescence and cortical transit times. Explore whether the perfusion was increased in the above areas before and after bypass surger.
Results Cortical hemodynamic parameter slope value in MMD group was 44.21±11.59, which was lower than 101.00±52.40 in ACVD group and 163.20±12.19 in control group. The MVTT in MMD, ACVD and control group were (5.75±0.23) s, (4.57±1.21) s, and (3.27±0.57) s respectively. There are statistical differences in the slope value and MVTT of cortical artery between patients with MMD, ACVD and control group (P<0.05). The slope value of receptor arterial branches was significantly increased after bypass:surgery receptor artery (45.61±13.05 vs 89.32±5.41), receptor arterial branches (43.70±11.57 vs 96.66±15.82), adjacent arteries (45.92±14.92 vs 77.80±14.30). There are statistical differences in the slope value before and after bypass surgery in above groups (P<0.05). After bypass surgery, the local MVTT become shorter:receptor artery ([5.75±0.58] s vs [2.04±0.54] s), adjacent arteries ([5.54±0.26] s vs [2.97±0.73] s) (P<0.05).
Conclusion Intraoperative ICG angiography combined with hemodynamic parameter analysis obtained by Flow 800 software is a convenient and effective method to evaluate the hemodynamic features of MMD and ACVD. For patients with MMD or ACVD underwent STA-MCA bypass surgery, ICG angiography and hemodynamic parameter analysis can provide a rapid estimation for whether the anastomosis is opened, and whether the cortex perfusion is improved after revascularization.
