Abstract 110: Pre-Operative Risks of Major Adverse Cerebrovascular Events in Pediatric Moyamoya Disease

Abstract

Objective: This study aims to evaluate the risk of cerebrovascular events in pediatric MMD during the preoperative waiting period, and explore the related risk factors and appropriate operation opportunities. Methods: This study is an observational cohort study, including 736 children with MMD from their initial visit until the completion of surgery. The patients were divided into three subgroups according to their initial symptoms: no cerebrovascular event group, cerebral infarction (CI) group, and transient ischemic attack (TIA) group. Results: A total of 736 children with MMD were included, and the median time from diagnosis to surgery was 13 months (IQR: 4-33). During the waiting period, 166 patients (26.6%) experienced CI, and 17 patients (2.3%) had cerebral hemorrhage. The incidence rates of CI and cerebral hemorrhage were 10.49 and 1.08 per 1000 person-months, respectively. Cox regression analysis revealed that male (HR: 1.586; p=0.004), CI at onset (HR: 2.889; p<0.001) or TIA at onset (HR: 1.943; p=0.006), age≤3 years at onset (HR: 2.208; p<0.001), and involvement of the posterior cerebral arteries (HR: 1.670; p=0.001) were risk factors for CI during the waiting period. No specific risk factors for cerebral hemorrhage during the waiting period were identified. For patients with CI at onset, the risk of CI during the waiting period significantly increased when the waiting time exceeded 2.5 months (AUC=0.722, specificity=0.561, sensitivity=0.882; OR: 8.253; p<0.001). In pediatric MMD patients without cerebrovascular events at onset, the risk of preoperative cerebral hemorrhage significantly increased when the waiting time exceeded 5 years (AUC=0.761, specificity=0.856, sensitivity=0.571; OR: 6.667; p=0.018). No significant correlation was found between waiting time and preoperative CI in TIA patients. Conclusions: For children MMD with CI or TIA at onset, early surgery is recommended, especially for younger patients and those with involvement of the posterior circulation. For patients with CI at onset, surgery should be performed within 2.5 months of waiting, while patients without cerebrovascular events should undergo surgery within 5 years.