{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T08:34:44Z","timestamp":1775032484868,"version":"3.50.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether intraoperative fractional flow reserve (FFR) pressure wire measurements combined with FLOW800 imaging analysis effectively predict postoperative cerebral perfusion abnormalities following superficial temporal artery to middle cerebral artery (STA\u2013MCA) bypass surgery in patients with Moyamoya disease (MMD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on 26 patients diagnosed with MMD who underwent STA\u2013MCA bypass at our institution between November 2023 and January 2025. Intraoperative graft pressures were assessed using FFR pressure wires. Concurrently, FLOW800 imaging provided quantitative microcirculatory parameters, including delay time (DT), flow velocity, rise time (RT), and fluorescence intensity. Postoperative cerebral perfusion-related complications were documented. ROC analyses were reported with 95% confidence intervals to evaluate the predictive value of intraoperative parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Postoperative cerebral perfusion abnormalities occurred in 9 out of 26 patients (34.6%). Among them, 3 patients (11.5%) had diffusion-weighted MRI (DWI)-confirmed acute ischemic lesions (major complications), whereas the remaining 6 patients experienced transient neurological symptoms that completely resolved within 2 weeks to 1 month without radiographic infarction. A higher pressure gradient across the bypass graft (\u0394P) and prolonged rise time (RT) in the proximal recipient artery significantly correlated with postoperative perfusion abnormalities (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). A \u0394P cutoff &amp;gt;32\u2005mmHg showed a sensitivity of 77.8% and a specificity of 64.7%. The combined predictive capability of \u0394P and RT yielded an area under the receiver operating characteristic (ROC) curve (AUC) of 0.82 (95% CI, 0.61\u20130.99), surpassing the predictive value of either parameter alone (AUC 0.79 for \u0394P and 0.79 for RT).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intraoperative monitoring with FFR pressure wire combined with FLOW800 imaging may help identify MMD patients at increased risk of early postoperative cerebral perfusion abnormalities after STA\u2013MCA bypass. The integration of \u0394P and RT appears to improve predictive accuracy and may support perioperative risk stratification, although larger prospective studies are required before routine decision-making can be recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1792515","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:42:01Z","timestamp":1775022121000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative application of FFR pressure wire and FLOW800 imaging as predictors of postoperative cerebral perfusion abnormalities in Moyamoya disease"],"prefix":"10.3389","volume":"13","author":[{"given":"Huan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Donglei Brain Hospital","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shubin","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Donglei Brain Hospital","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Helmy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Donglei Brain Hospital","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donglei","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Donglei Brain Hospital","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Donglei Brain Hospital","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1159\/000513289","article-title":"A novel hyperspectral imaging system for intraoperative prediction of cerebral hyperperfusion syndrome after superficial temporal artery-middle cerebral artery anastomosis in patients with Moyamoya disease","volume":"50","author":"Iwaki","year":"2021","journal-title":"Cerebrovasc Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"107222","DOI":"10.1016\/j.jstrokecerebrovasdis.2023.107222","article-title":"Hyperperfusion syndrome after superficial temporal artery-middle cerebral artery bypass for non-Moyamoya steno-occlusive disease","volume":"32","author":"Turpin","year":"2023","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2785","DOI":"10.1007\/s10143-020-01459-0","article-title":"Postoperative stroke and neurological outcomes in the early phase after revascularization surgeries for Moyamoya disease: an age-stratified comparative analysis","volume":"44","author":"Araki","year":"2021","journal-title":"Neurosurg Rev"},{"key":"B4","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1159\/000508827","article-title":"Measurement of intraoperative graft flow predicts radiological hyperperfusion during bypass surgery in patients with Moyamoya disease","volume":"10","author":"Nakamura","year":"2020","journal-title":"Cerebrovasc Dis Extra"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.3171\/2022.8.JNS22336","article-title":"Short- and long-term outcomes of Moyamoya patients post-revascularization","volume":"138","author":"Teo","year":"2022","journal-title":"J Neurosurg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1756286420921092","DOI":"10.1177\/1756286420921092","article-title":"A critical appraisal of bypass surgery in Moyamoya disease","volume":"13","author":"Moussouttas","year":"2020","journal-title":"Ther Adv Neurol Disord"},{"key":"B7","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s41016-024-00367-2","article-title":"Assessing donor-recipient arterial pressure dynamics in STA-MCA bypass for Moyamoya disease","volume":"10","author":"Helmy","year":"2024","journal-title":"Chin Neurosurg J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"V16","DOI":"10.3171\/2021.10.FOCVID21191","article-title":"Application of FLOW 800 in extracranial-to-intracranial bypass surgery for Moyamoya disease","volume":"6","author":"Yim","year":"2022","journal-title":"Neurosurg Focus Video"},{"key":"B9","doi-asserted-by":"publisher","first-page":"363","DOI":"10.3171\/2024.4.JNS24713","article-title":"Assessing superficial temporal artery\u2013middle cerebral artery anastomosis patency using FLOW 800 hemodynamics","volume":"142","author":"Kim","year":"2024","journal-title":"J Neurosurg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.3171\/2016.11.JNS162403","article-title":"Correlation between reduction in microvascular transit time after superficial temporal artery\u2013middle cerebral artery bypass surgery for Moyamoya disease and the development of postoperative hyperperfusion syndrome","volume":"128","author":"Yang","year":"2017","journal-title":"J Neurosurg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/j.wneu.2019.11.065","article-title":"Cerebral hyperperfusion syndrome after revascularization surgery in patients with Moyamoya disease: systematic review and meta-analysis","volume":"135","author":"Yu","year":"2020","journal-title":"World Neurosurg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e750","DOI":"10.1016\/j.wneu.2018.07.258","article-title":"Predicting the occurrence of hemorrhagic cerebral hyperperfusion syndrome using regional cerebral blood flow after direct bypass surgery in patients with Moyamoya disease","volume":"119","author":"Ishikawa","year":"2018","journal-title":"World Neurosurg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1177\/15910199211011860","article-title":"Cerebral hyperperfusion syndrome after intracranial stenting: case report and systematic review","volume":"27","author":"Diana","year":"2021","journal-title":"Interv Neuroradiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"775","DOI":"10.2176\/nmc.ra.2015-0063","article-title":"Significance of cerebral blood flow analysis in the acute stage after revascularization surgery for Moyamoya disease","volume":"55","author":"Fujimura","year":"2015","journal-title":"Neurol Med Chir"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1241760","DOI":"10.3389\/fneur.2023.1241760","article-title":"Application of intraarterial superselective indocyanine green angiography in bypass surgery for adult Moyamoya disease","volume":"14","author":"Ni","year":"2023","journal-title":"Front Neurol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"18352","DOI":"10.1038\/s41598-023-45676-1","article-title":"The value of indocyanine green-FLOW800 in microvasculature for predicting cerebral hyperperfusion syndrome in Moyamoya disease patients","volume":"13","author":"Guo","year":"2023","journal-title":"Sci Rep"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1484224","DOI":"10.3389\/fneur.2024.1484224","article-title":"The significance of post-bypass blood flow model in side-to-side bypass for Moyamoya disease in predicting postoperative cerebral hyperperfusion syndrome","volume":"15","author":"Wan","year":"2024","journal-title":"Front Neurol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1494","DOI":"10.1161\/STROKEAHA.122.041932","article-title":"Five-year stroke risk and its predictors in asymptomatic Moyamoya disease: asymptomatic Moyamoya registry (AMORE)","volume":"54","author":"Kuroda","year":"2023","journal-title":"Stroke"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e55081","DOI":"10.7759\/cureus.55081","article-title":"Suzuki stage VI unilateral Moyamoya disease presenting with massive intraventricular hemorrhage","volume":"16","author":"Hirano","year":"2024","journal-title":"Cureus"},{"key":"B20","doi-asserted-by":"publisher","first-page":"353","DOI":"10.7759\/cureus.55081","article-title":"Analysis of middle cerebral artery blood flow in Moyamoya disease and comparison of orthodromic and antidromic bypass","volume":"22","author":"Li","year":"2022","journal-title":"Chin J Contemp Neurol Neurosurg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1792515\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:42:02Z","timestamp":1775022122000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1792515\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":20,"alternative-id":["10.3389\/fsurg.2026.1792515"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1792515","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"article-number":"1792515"}}