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Postoperative cerebral infarction after revascularization in patients with moyamoya disease: Incidence and risk
Jiaxiong Wang1, Hanqiang Jiang2, Jinwei Tang1
1Department of Neurosurgery, South Yunnan Central Hospital of Yunnan Province (The First People's Hospital of Honghe Prefecture), Mengzi, China.
Objectives:
Cerebral infarction is the major complication of revascularization surgery in patients with moyamoya disease (MMD), and we analyzed the possible causes of cerebral infarction after revascularization surgery for MMD.
Methods:
MMD patients who were admitted and underwent surgical revascularization at Shanghai Huashan Hospital from January 2019 to December 2021 were retrospectively analyzed.
Results:
A total of 815 patients and 890 revascularization surgeries (677 first revascularization surgeries and 213 second revascularization surgeries) were included in this study; 453 (50.9%) were performed on the left side and 437 (49.1%) on the right side, with 779 (87.5%) combined procedures and 111 (12.5%) indirect bypasses included. The mean patient age at the time of these procedures was 44.6 ± 11.7 years (range 6-72 years). Postoperative cerebral infarctions were observed in 46 (5.17%) surgeries, among which 31 occurred after left hemisphere revascularization surgeries, with an incidence of 6.84%, and 15 occurred after right hemisphere revascularization surgeries, with an incidence of 3.43%. Of these, 30 (65.2%) occurred in the operated hemispheres, 2 (4.3%) in the contralateral hemisphere and 13 (28.3%) in the bilateral hemisphere. There were 11 cases of massive infarction (23.9%). The incidence of postoperative infarction in patients undergoing the first revascularization was 6% (41/677) and 2.3% (5/213) in the second revascularization surgeries. Initial presentation as infarction (P < 0.001), initial presentation as hemorrhage (P < 0.001), hypertension (P = 0.018), diabetes (P = 0.006), 1st or 2nd surgery and surgical side (P = 0.007) were found to be related to postoperative cerebral infarction. Initial presentation as infarction (OR = 2.934, 95% CI 1.453-5.928, P = 0.003), initial presentation as hemorrhage (OR = 0.149, 95% CI 0.035-0.641, P = 0.011), and 1st or 2nd surgery and surgical side (OR = 1.66, 95% CI 1.106-2.491, P = 0.014) were independently associated with cerebral infarction after revascularization surgeries.
Conclusions:
In patients with MMD undergoing surgical revascularization, initial presentation as infarction and first revascularization surgery performed on the left hemisphere are independent risk factors for postoperative cerebral infarction, whereas initial presentation as hemorrhage is a protective factor.
Insights
First revascularization surgery for moyamoya disease (MMD) on the left hemisphere increases the risk of cerebral infarction. However, initial presentation with hemorrhage acts as a protective factor against this complication.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Moyamoya disease (MMD) poses a significant risk of cerebral infarction, particularly after revascularization surgery.
- Identifying risk factors for postoperative cerebral infarction is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the potential causes of cerebral infarction following revascularization surgery in patients with MMD.
- To identify independent risk factors associated with postoperative cerebral infarction in MMD patients.
Main Methods:
- Retrospective analysis of 815 MMD patients who underwent 890 revascularization surgeries between January 2019 and December 2021.
- Data collected included patient demographics, surgical details, and postoperative outcomes, specifically cerebral infarction incidence.
- Statistical analysis was performed to identify factors associated with cerebral infarction, including initial presentation, comorbidities, and surgical characteristics.
Main Results:
- A total of 46 (5.17%) postoperative cerebral infarctions were observed across 890 surgeries.
- The incidence of infarction was higher after first revascularization (6%) compared to second revascularization (2.3%).
- Independent risk factors for cerebral infarction included initial presentation as infarction and first revascularization surgery on the left hemisphere; initial presentation as hemorrhage was a protective factor.
Conclusions:
- Initial presentation as infarction and undergoing a first revascularization surgery on the left hemisphere are significant independent risk factors for postoperative cerebral infarction in MMD patients.
- Initial presentation as hemorrhage appears to be a protective factor against postoperative cerebral infarction in this patient cohort.
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