Significance of Focal Cerebral Hyperperfusion as a Cause of Transient Neurologic Deterioration After Extracranial-Intracranial Bypass for Moyamoya Disease: Comparative Study With Non-Moyamoya Patients Using N-Isopropyl-p-[123I]Iodoamphetamine Single-Photon Emission Computed Tomography

BACKGROUND: Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis prevents cerebral ischemic attack by improving cerebral blood flow in patients with occlusive cerebrovascular disease and hemodynamic compromise. Recent evidence suggests that focal cerebral hyperperfusion is a potential complication of this procedure for moyamoya disease. OBJECTIVE: To clarify the exact differences in the incidence and clinical manifestations of this phenomenon between patients with and without moyamoya disease. METHODS: N-isopropyl-p-[I-123]iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 121 hemispheres from 86 consecutive patients with moyamoya disease (2-67 years of age; mean, 34.3 years) and on 28 hemispheres from 28 non-moyamoya patients (12-67 years of age; mean, 56.5 years). The incidence of symptomatic hyperperfusion, defined as a significant focal increase in cerebral blood flow at the site of the anastomosis that is responsible for the apparent neurological signs, was compared between groups. RESULTS: Symptomatic cerebral hyperperfusion including mild focal neurological signs was seen in 25 patients with moyamoya disease (26 hemispheres, 21.5%) but in none of the patients without moyamoya disease (P = .0069). Multivariate analysis revealed that moyamoya disease was significantly associated with the development of symptomatic cerebral hyperperfusion (P = .0008). All patients with symptomatic hyperperfusion were relieved by intensive blood pressure control, and no patients suffered from permanent neurological deficit caused by hyperperfusion. CONCLUSION: Symptomatic cerebral hyperperfusion is a potential complication of STA-MCA anastomosis, especially in patients with moyamoya disease. Accurate diagnosis and adequate management of hyperperfusion are recommended, especially in patients with moyamoya disease.