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Imaging of moyamoya lesions and 5-month follow-up. Before surgery, moyamoya lesions were observed on the right (a) and left (b) internal carotid artery angiograms, revealing bilateral stenosis of the internal carotid arteries termination (black arrows), with moyamoya collaterals (#). Magnetic resonance imaging (c-f) found asymmetric enlargement of the medullary veins in relation with cerebral hypoperfusion (*) visible on the T2-GE sequence (c), associated with bilateral watershed ischemic lesions on FLAIR (f) (white arrow). Perfusion imaging pointed out severe hypoperfusion in the right frontal junctional territory (squared dots) on the cerebral blood flow cartography (CBV) (d) and the TMAX cartography (e). A five-month follow-up scan (g-i) showed significant improvement of the left frontal lobe perfusion after surgery with: (1) an increase in cerebral blood flow (d vs. g) (squared dots), and (2) shrinkage of delayed perfusion areas on TMAX >6s (e vs. h) (rectangular dots). No recurrent ischemic lesions were observed after surgery. Preoperative ischemic lesions progressed into lacunar lesions (f vs. i) (white arrowhead).
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F1
A cerebral angiogram showed worsening of the M1 stenosis and occlusion of the two anterior cerebral arteries (Figures 1a,b). Perfusion MRI showed severe bilateral frontal hypoperfusion of cerebral blood flow, and Tmax cartography (Figures 1d,e). Figure 1 illustrates the increase in brain perfusion on cerebral blood flow cartography and the shrinkage of delayed perfusion areas (TMAX >6s) on TMAX cartography, which was enabled by the postoperative development of collateral vessels (Figures 1g,h).
PMC8044811_05
Timeline table, resuming evolution of neurological and cardiac disease. The patient's written consent was obtained for publication.
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F2
The last follow-up, 1 year after the transplant, was excellent (Figure 2).