Cerebral blood flow and metabolism of hyperperfusion after cerebral revascularization in patients with moyamoya disease

Yasuyuki Kaku, Koji Iihara, Norio Nakajima, Hiroharu Kataoka, Kenji Fukuda, Jun Masuoka, Kazuhito Fukushima, Hidehiro Iida, Nobuo Hashimoto

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Abstract

In moyamoya disease (MMD), surgical revascularization may be complicated with postoperative hyperperfusion. We analyzed cerebral perfusion and metabolism using positron emission tomography (PET) or single-photon emission computed tomography (SPECT) before and after bypass surgery on 42 sides of 34 adult patients with MMD. In seven cases (16.7%) with symptomatic hyperperfusion, diagnosed by qualitative 123 I-iodoamphetamine (IMP) SPECT, a subsequent PET study during postoperative subacute stages revealed significantly increased cerebral blood flow (CBF) from 34.1±8.2 to 74.3±12.8 mL/100 g per minute (P=0.01), a persistent increase in cerebral blood volume (CBV) from 5.77±1.67 to 7.01±1.44 mL/100 g and a significant decrease in oxygen extraction fraction (OEF) from 0.61±0.09 to 0.40±0.08 (P=0.01). Mean absolute CBF values during symptomatic hyperperfusion were more than the normal control 2 standard deviations, the predefined criteria of PET. Interestingly, two patients with markedly increased cerebral metabolic rate of oxygen (CMRO 2) at hyperperfusion were complicated with postoperative seizure. Among preoperative PET parameters, increased OEF was the only significant risk factor for symptomatic hyperperfusion (P=0.05). This study revealed that symptomatic hyperperfusion in MMD is characterized by temporary increases in CBF >100% over preoperative values caused by prolonged recovery of increased CBV.

Original languageEnglish
Pages (from-to)2066-2075
Number of pages10
JournalJournal of Cerebral Blood Flow and Metabolism
Volume32
Issue number11
DOIs
Publication statusPublished - Nov 1 2012
Externally publishedYes

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All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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