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. 2024 Feb:151:111-114.
doi: 10.1016/j.pediatrneurol.2023.12.002. Epub 2023 Dec 6.

Transcranial Doppler in Childhood Moyamoya: An Underutilized Tool?

Lisa R Sun  1 , John R Gatti  2 , Syed Ameen Ahmad  2 , Noah Burton  3 , Wendy Ziai  4 , Rebecca F Gottesman  5 , Lori C Jordan  6
Affiliations

Transcranial Doppler in Childhood Moyamoya: An Underutilized Tool?

Lisa R Sun et al. Pediatr Neurol. 2024 Feb.

Abstract

Background: Children with moyamoya are at high risk for incident and recurrent stroke. Transcranial Doppler (TCD) ultrasound is an attractive option to screen high-risk populations for moyamoya and to provide stroke risk stratification information due to its safety and cost-effectiveness. We used TCD to evaluate cerebral blood flow velocities in children with presurgical moyamoya and to determine if velocities differ between children with stable and unstable disease.

Methods: Fourteen participants aged ≤21 years with a radiographic diagnosis of moyamoya or moyamoya-like arteriopathy underwent a research TCD at a median age of 7.2 years. TCDs were performed outside of the setting of acute stroke and before surgical revascularization. Arteriopathy was classified as unstable if the participant had a stroke or transient ischemic attack within three months preceding the TCD.

Results: Middle cerebral artery and internal carotid artery (ICA) blood flow velocities were elevated. The median M1 velocity was 138 cm/s (interquartile range [IQR] 106 to 168). Individual M1 flow velocities were a median of 5.0 S.D.s above age-based normative values. The median distal ICA velocity was 146 cm/s (IQR 124 to 163). Individual ICA flow velocities were a median of 5.9 S.D.s above normative values. Participants with unstable arteriopathy had higher M1 velocities compared with those with stable arteriopathy (170 vs 119 cm/s, P = 0.0003). We did not identify velocity differences based on comorbid conditions or age.

Conclusions: These preliminary data suggest that TCD is a promising tool for screening for cerebral arteriopathies in high-risk pediatric populations and assessment for unstable disease.

Keywords: Arteriopathy; Ischemic stroke; Moyamoya; Pediatric stroke; Transcranial Doppler.

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Conflict of interest statement

Declaration of competing interest None

Figures

Figure.
Figure.
Distribution of MCA (left) and ICA (right) cerebral blood flow velocities in participants with unstable (black circles) and stable (open circles) cerebral arteriopathy.
See this image and copyright information in PMC

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