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Risk Factors for Specific Postoperative Ischemic Complications in Patients with Moyamoya Disease: A Single-Center
Huan Zhu1, Qihang Zhang, Wenjie Li
1Capital Medical University, Beijing Tiantan Hospital, Department of Neurosurgery, Beijing, China.
Aim:
To evaluate and compare postoperative ischemic complications to determine the risk factors for ischemic complications following revascularization surgery for Moyamoya disease (MMD).
Material And Methods:
This single-center retrospective study included 266 procedures between 2016 and 2021. Three types of revascularization approaches including direct bypass, indirect bypass, and combined bypass were performed. To identify risk factors for postoperative ischemic complications and contralateral cerebral infarction, preoperative clinical characteristics and radiographic features were examined using multivariate and ordinal logistic regression analyses.
Results:
Postoperative ischemic complications occurred in 103 (6.6%) procedures. Ischemic presentation (p=0.001, odds ratios [OR] 5.59, 95% confidence interval [CI] 2.05-15.23), hypertension (p=0.030, OR 2.75, 95%CI 1.11- 6.83), advanced Suzuki stage (p=0.006, OR 3.19, 95%CI 1.40-7.26), and collateral circulation (p=0.001 OR 0.17, 95%CI 0.06-0.47) were risk factors for postoperative ischemic complications. Ordinal regression analysis revealed that unilateral involvement (p=0.043, OR 2.70, 95%CI 0.09-5.31), hemorrhagic presentation (p=0.013, OR 3.45, 95%CI 0.72-6.18), surgical approach (p=0.032, OR -1.38, 95%CI -2.65, -0.12), and collateral circulation [p=0.043, OR -1 .27, 95%CI -2.51, -0.04)] were associated with the type of ischemic complications. History of hypertension (p=0.031) and contralateral computed tomography (CT) perfusion stage (p=0.045) were associated with contralateral infarction.
Conclusion:
Inability of cerebral vessels to withstand changes in blood pressure induced by revascularization-related hemodynamic instability might be associated with postoperative complications in patients with Moyamoya disease.
Insights
Postoperative ischemic complications after Moyamoya disease revascularization are linked to ischemic presentation, hypertension, advanced disease stage, and poor collateral circulation. Hemodynamic instability may contribute to these risks.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of the internal carotid arteries.
- Revascularization surgery is performed to restore cerebral blood flow, but carries risks of ischemic complications.
Purpose of the Study:
- To evaluate and compare postoperative ischemic complications following revascularization surgery for Moyamoya disease (MMD).
- To determine the risk factors associated with these complications.
Main Methods:
- A single-center retrospective study of 266 MMD revascularization procedures (2016-2021).
- Analysis of direct, indirect, and combined bypass techniques.
- Multivariate and ordinal logistic regression used to identify risk factors for postoperative ischemic complications and contralateral cerebral infarction.
Main Results:
- Postoperative ischemic complications occurred in 6.6% of procedures.
- Risk factors included ischemic presentation, hypertension, advanced Suzuki stage, and poor collateral circulation.
- Unilateral involvement, hemorrhagic presentation, surgical approach, and collateral circulation were associated with the type of ischemic complication. History of hypertension and contralateral CT perfusion stage were linked to contralateral infarction.
Conclusions:
- Cerebral hemodynamic instability post-revascularization may contribute to ischemic complications in MMD patients.
- Identifying and managing risk factors like hypertension and optimizing collateral circulation are crucial for improving outcomes.
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