Cerebral blood flow and metabolism during hyperperfusion after cerebral revascularization for Moyamoya disease

Abstract

Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease of unknown etiology characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. The disease can cause ischemic and hemorrhage injuries. A hyperperfusion phenomenon complicated with transient neurologic deterioration may be recognized in the acute stage after direct revascularization surgery for MMD, but its pathology is unclear. We evaluated cerebral blood flow and metabolism during hyperperfusion using 15 O-gas PET in the acute stage after surgery to clarify the pathological cause of hyperperfusion. During the hyperperfusion state, cerebral blood flow (CBF) increases markedly, and there was an increase in cerebral blood volume (CBV) as well as a decrease in oxygen extraction fraction (OEF). However, other factors that could not be evaluated by analysis of cerebral hemodynamics may be involved in symptomatic hyperperfusion, and we hope to accumulate more knowledge in the future.