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Reduction of systemic hypertension following cerebral revascularization surgery for children with moyamoya
Taqwa Ahmad1, Lauren Harris2, Vijeya Ganesan3,4
11University College London Medical School, London.
Insights
Indirect revascularization surgery reduced hypertension in pediatric moyamoya patients. This suggests a delayed effect of surgery on blood pressure control, potentially avoiding unnecessary medication.
Area of Science:
- Neurology
- Pediatric Surgery
- Cardiovascular Research
Background:
- Moyamoya disease is a rare cerebrovascular disorder affecting children.
- Hypertension is a common comorbidity in pediatric moyamoya patients.
- Indirect revascularization is a surgical approach to improve cerebral blood flow.
Purpose of the Study:
- To determine if indirect revascularization surgery reduces systemic blood pressure (BP) in pediatric moyamoya patients.
- To analyze BP changes over time following indirect revascularization.
Main Methods:
- Retrospective cohort study of 63 pediatric moyamoya patients.
- BP measurements collected preoperatively and postoperatively (≥ 3 months).
- Hypertension defined by age, sex, and height-adjusted BP percentiles; analyzed using chi-square and paired t-tests.
Main Results:
- Preoperatively, 33.9% had systolic and 14.5% had diastolic hypertension.
- Postoperatively, hypertension decreased to 16.1% (systolic) and 4.8% (diastolic) (p=0.02 for systolic).
- No significant change in mean arterial pressure (p=0.52).
Conclusions:
- Indirect revascularization is associated with a reduction in hypertension in pediatric moyamoya patients.
- The observed BP reduction may be due to delayed neovascularization and improved cerebral perfusion.
- Findings may help guide antihypertensive medication use, reducing risks of hypotension and stroke.
Objective:
The aim of this study was to evaluate whether indirect revascularization is associated with a reduction in systemic blood pressure (BP) over time in pediatric patients with moyamoya.
Methods:
This is a retrospective cohort study of pediatric patients with moyamoya who were treated at a single institution between June 2019 and January 2025. BP measurements were collected preoperatively (preadmission clinic evaluation) and postoperatively (outpatient follow-up evaluation at ≥ 3 months). BP was categorized as hypertensive or normotensive based on percentile thresholds adjusted for age, sex, and height, with measurements at the 95th and 99th percentiles indicating hypertension. The chi-square test was used to assess changes in hypertensive classification, and the paired t-test was used to compare mean absolute BP values at the two time points.
Results:
Overall, 63 children (39 female, mean age 11 years) with moyamoya who underwent indirect revascularization surgery were included in this analysis. The mean follow-up duration was 20.8 months. Preoperatively, 21 patients (33.9%) were classified as hypertensive for systolic BP and 9 (14.5%) for diastolic BP. These measurements were acquired preoperatively at a mean of 3.5 months (range 1 day to 11 months). Postoperatively, the proportion of hypertensive patients decreased to 10 (16.1%) and 3 (4.8%) for systolic BP and diastolic BP (p = 0.02 and 0.06, respectively). There was no significant change between the preoperative and postoperative mean arterial pressure measurements (77.3 mm Hg vs 76.2 mm Hg, respectively; p = 0.52).
Conclusions:
Indirect revascularization surgery in pediatric patients with moyamoya was associated with a reduction in hypertension over time. This might reflect the delayed physiological effect of indirect revascularization, in which neovascularization and improved cerebral perfusion typically develop 3-6 months after surgery. Understanding BP changes following surgery might help avoid unnecessary use of antihypertensive drugs, which carry risk of precipitating hypotension and thus stroke.