Perioperative flow and blood pressure markers predict hyperperfusion after moyamoya bypass

A study of 284 hemispheres in 218 adults with moyamoya disease assessed perioperative hemodynamic and blood pressure markers for cerebral hyperperfusion syndrome (CHS) after STA–MCA bypass. CHS occurred in 25.4% of hemispheres; a three-marker model showed an area under the curve of 0.88.

CHS occurred in 25.4% of analyzed hemispheres.
Three perioperative markers formed a model with AUC 0.88.
Model sensitivity was 80.6%; specificity was 84.9%.
Thresholds require further validation before routine use.

This study examined whether perioperative blood flow and blood pressure measures could predict cerebral hyperperfusion syndrome (CHS) after superficial temporal artery–middle cerebral artery (STA–MCA) bypass in adults with moyamoya disease. The analysis included 284 hemispheres from 218 patients. Investigators monitored hemodynamics using carotid Doppler ultrasound and an intraoperative microprobe Doppler, alongside perioperative blood pressure measurements, and compared patients who developed CHS with those who did not.

CHS occurred in 72 hemispheres (25.4%). Multivariable analysis identified three predictors: a greater than 8.8-fold increase in proximal M4 mean flow velocity after versus before anastomosis (OR 1.37, 95% CI 1.18–1.59), postoperative day 1 systolic blood pressure above 127 mm Hg (OR 1.13, 95% CI 1.07–1.19), and postoperative day 3 STA time-averaged peak velocity above 66 cm/sec (OR 1.02, 95% CI 1.00–1.05). The combined model had an AUC of 0.88 (95% CI 0.85–0.94), with 80.6% sensitivity and 84.9% specificity.

The findings suggest potential risk markers for postoperative CHS, but the abstract does not establish that using these thresholds improves outcomes. The model’s performance and applicability require assessment beyond this reported cohort before it can guide routine postoperative management.

In practice

For adults with moyamoya disease undergoing STA–MCA bypass, the study identifies intraoperative proximal M4 flow-velocity increase and postoperative blood pressure and STA flow-velocity thresholds associated with CHS. A combined model had an AUC of 0.88 in the reported cohort, suggesting potential utility for risk assessment. However, this is observational prediction evidence; the abstract does not report external validation or demonstrate that acting on the thresholds prevents CHS or improves outcomes, so it does not establish a basis for changing care protocols.

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Source

Journal of Neurosurgery: Prediction of cerebral hyperperfusion syndrome in adults with moyamoya disease after combined bypass surgery using perioperative hemodynamic and blood pressure changes ↗

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