{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T23:44:31Z","timestamp":1780616671156,"version":"3.54.1"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82272017"],"award-info":[{"award-number":["82272017"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["CNS Neurosci Ther"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cerebral hyperperfusion syndrome (CHS) is a serious complication following revascularization in moyamoya disease (MMD) patients, yet reliable predictors remain scarce. This study aims to evaluate subcortical hemodynamics intraoperatively using a novel ultrasound imaging technique, synchronous arbitrary gate spectral Doppler (SAGSD), and to identify indicators associated with CHS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of thirty adult MMD patients undergoing revascularization were included. Intraoperative SAGSD imaging, conventional Doppler ultrasound, and indocyanine green videoangiography (ICG\u2010VA) were performed to assess subcortical hemodynamics at multiple sites before and after anastomosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All thirty patients underwent revascularization, and five of the six CHS patients exhibited a distinctive \u201cmountain\u201d sign on SAGSD, characterized by three or more discrete velocity peaks within a single cardiac cycle observed simultaneously across two or more sampling sites. The CHS patients showed a significant increase in velocity\u2010time integral (VTI) change (median \u0394\u2009+\u20090.48\u2009cm [95% CI, 0.31 to 0.65],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) post\u2010anastomosis on SAGSD, while conventional Doppler showed no significant change in flow velocity (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Notably, in CHS patients, ICG\u2010VA showed no statistical difference in flow velocity, delay, and time to peak after anastomosis (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05), whereas SAGSD demonstrated hemodynamic changes such as VTI (median \u0394 + 0.67\u2009cm [95% CI, 0.43\u20130.90],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) via Doppler spectrum.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SAGSD enables highly sensitive, multi\u2010position, and contrast\u2010free hemodynamic evaluation of deep cerebral microvasculature. The \u201cmountain\u201d sign, a novel spectral morphology corroborated by quantitative VTI elevation, is a specific intraoperative biomarker strongly associated with CHS, offering a potential predictor for early intervention and improved surgical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cns.70829","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T05:01:06Z","timestamp":1773291666000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Unusual Synchronous Arbitrary\u2010Gate Doppler Spectra Enable Intraoperative Hemodynamic Warning of Cerebral Hyperperfusion Syndrome on Moyamoya Disease"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3531-6737","authenticated-orcid":false,"given":"Xiandi","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Ultrasound Huashan Hospital, Fudan University  Shanghai 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