Intraoperative application of FFR pressure wire and FLOW800 imaging as predictors of postoperative cerebral perfusion abnormalities in Moyamoya disease

Objective: 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-MCA) bypass surgery in patients with Moyamoya disease (MMD). Methods: A retrospective analysis was conducted on 26 patients diagnosed with MMD who underwent STA-MCA 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. Results: < 0.05). A ΔP cutoff >32 mmHg showed a sensitivity of 77.8% and a specificity of 64.7%. The combined predictive capability of ΔP and RT yielded an area under the receiver operating characteristic (ROC) curve (AUC) of 0.82 (95% CI, 0.61-0.99), surpassing the predictive value of either parameter alone (AUC 0.79 for ΔP and 0.79 for RT). Conclusions: 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-MCA bypass. The integration of ΔP 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.