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Risk Factors and Imaging Biomarkers Associated With Perioperative Stroke in Pediatric Moyamoya Arteriopathy
Sarah E Gardner Yelton1, John Gatti2, Malik Adil3,4
1Department of Anesthesia and Critical Care Medicine, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA.
Insights
Children undergoing revascularization surgery for moyamoya arteriopathy face stroke risks. Younger age and recent transient ischemic attacks (TIAs) significantly increase postoperative stroke risk in pediatric moyamoya patients.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Stroke
Background:
- Moyamoya arteriopathy presents a high risk of perioperative ischemic stroke in affected patients.
- Revascularization surgery is a critical intervention for moyamoya arteriopathy, yet carries inherent risks.
Purpose of the Study:
- To identify preoperative clinical and neuroimaging biomarkers associated with postoperative stroke and transient ischemic attack (TIA) in pediatric moyamoya patients.
- To evaluate risk factors for perioperative stroke and TIA following revascularization surgery in children.
Main Methods:
- Retrospective chart review of pediatric patients undergoing revascularization for moyamoya over 15 years.
- Inclusion criteria: 53 patients undergoing 69 surgeries.
- Analysis of clinical predictors and neuroimaging (Suzuki stage, Composite Cerebrovascular Stenosis Score) for stroke/TIA within 7 days post-surgery.
Main Results:
- Younger age at surgery (P=.004) was a significant risk factor for postoperative stroke/TIA.
- Transient ischemic attack (TIA) within one month prior to surgery (P<.001) was a significant predictor.
- Children under 5 years old and those with recent preoperative ischemic events showed higher risk.
Conclusions:
- Younger children and those with recent TIAs are at elevated risk for perioperative stroke after moyamoya revascularization.
- Targeted interventions and further investigation of modifiable risk factors are crucial for this high-risk pediatric population.
Abstract:
Patients with moyamoya arteriopathy are at high risk for developing ischemic stroke in the perioperative period. We sought to evaluate whether preoperative clinical and neuroimaging biomarkers are associated with postoperative stroke and transient ischemic attack in children with moyamoya following revascularization surgery. We performed a retrospective chart review of pediatric patients who underwent revascularization surgery for moyamoya in the last 15 years. Fifty-three patients who underwent 69 surgeries met the inclusion criteria. We recorded clinical predictors of stroke or transient ischemic attack within 7 days following surgery. We used Suzuki stage and Composite Cerebrovascular Stenosis Score to analyze neuroimaging. Significant risk factors for developing postoperative stroke or transient ischemic attack were younger age at surgery (P = .004) and transient ischemic attack less than 1 month prior to surgery (P < .001). Children under 5 and those with recent preoperative ischemic events should be the focus of investigation to evaluate modifiable risk factors and targeted interventions.
