Analysis of Factors Related to Cerebral Infarction after Direct Bypass Surgery in Adults with Moyamoya Disease.

OBJECTIVE: High-risk factors of the patients with moyamoya disease (MMD) were analyzed to provide the basis for prediction and management of cerebral infarction after direct bypass surgery in adult MMD.

METHODS: 1. Retrospective analysis of clinical data was collected from adult MMD patients (n = 250) following superficial temporal artery-middle cerebral artery bypass surgery performed in our hospital from July 2013 to December 2017. Of the 250 patients, all underwent hemispherical bypass surgery, and bilateral surgery was performed on 14 patients. 2. Clinical data were analyzed based on sex, age, hypertension, diabetes, smoking history, history of alcohol use, presurgery cerebral infarction, transient ischemic attack, classification of clinical manifestations, clinical typing, Suzuki stage of surgical side, Suzuki stage of nonoperative side, preoperative Modified Rankin Scale (MRS), and lesions of the postoperative cycle or not.

RESULTS: 1. There were significant differences in classification of clinical manifestations, preoperative infarction, clinical typing, and Suzuki stage of nonoperative side (p < 0.05). 2. Logistic regression analysis showed that the independent factors affecting postoperative cerebral infarction were preoperative infarction and the Suzuki stage of nonoperative side (p < 0.05). The preoperative infarction (B 1.431, OR 4.184, 95% CI 1.217-14.382) and the Suzuki stage of nonoperative side (B 0.495, OR 1.640, 95% CI 1.207-2.227) were both risk factors.

CONCLUSION: The possibility of a new cerebral infarction in postoperative patients with a history of cerebral infarction was greater. The Suzuki stages (I-VI) of the nonoperative side was higher and associated with an increased probability of cerebral infarction after surgery.