[Role of Cerebral Hemodynamic and Metabolic Measurements in the Management of Ischemic Cerebrovascular Disease].

Understanding cerebral hemodynamics and metabolism is essential for the diagnosis and treatment of ischemic cerebrovascular disease. Advances in imaging modalities and techniques have enabled the quantitative assessment of hemodynamic compromise and facilitated tailored treatment. In acute ischemic stroke, computed tomography/magnetic resonance perfusion imaging supports the identification of salvageable tissue (the penumbra) and contributes to the selection of endovascular thrombectomy (EVT), particularly within the delayed time window. In chronic intracranial atherosclerotic disease (ICAD), quantitative assessments of cerebral blood flow (CBF), cerebrovascular reactivity (CVR), and oxygen extraction fraction (OEF) are useful for evaluating the risk of recurrence. The results of clinical trials for extracranial-intracranial bypass surgery vary due to differences in selection criteria and perioperative risks; therefore, patient selection based on rigorous hemodynamic evaluation is crucial. Repeated hemodynamic assessments are helpful in determining treatment strategies in moyamoya disease, for instance, which is progressive, even in asymptomatic cases. Postoperative cerebral hemodynamics may present with a mixture of hyperperfusion and hypoperfusion. To reduce the risk of postoperative complications, it is key to accurately understand the hemodynamic status. Collectively, the measurement of cerebral hemodynamics and metabolism is crucial for individualized and evidence-based management of ischemic cerebrovascular disease.