Blood Pressure and Transient Postoperative Neurologic Deterioration, Following Superficial Temporal-to-Middle Cerebral Artery Anastomosis in Adult Patients with Moyamoya Disease: A Retrospective Cohort Study.

Tak-Kyu Oh,Hee-Joon Bae,Jae-Seung Bang,Chang-Wan Oh,Ho-Young Lee,Young-Tae Jeon,Tac-Keun Kim,Seong-Eun Kim,Moon-Ku Han,Ji-Hyeon Kim

doi:10.3390/jcm10122567

Abstract

We investigated whether intraoperative systolic blood pressure (ISBP) is associated with the risk of transient neurologic deficits (TND) following superficial temporal-to-middle cerebral artery (STA-MCA) anastomosis in adult patients with moyamoya disease (MMD). In this retrospective observational study, data from adult patients with MMD who had undergone STA-MCA anastomosis at a single tertiary academic hospital during May 2003–April 2014 were examined. Data on patient characteristics were obtained from electronic medical records, including the details of comorbidities and laboratory findings. TND was the primary outcome of interest. Out of 192 patients (228 hemispheres), 66 (29%) hemispheres had TND after surgery. There were significant differences in ISBP between patients with and without TND. The lowest ISBP quartile was independently associated with TND (odds ratio: 5.50; 95% confidence interval: 1.96–15.46). Low ISBP might lead to TND after STA-MCA anastomosis in adult patients with MMD. In patients with poor perfusion status, low ISBP was associated with an increased risk of TND. Our findings suggest that strict ISBP control might be required to prevent TND after anastomosis in patients with MMD, in particular, in patients with poor perfusion status. Given limitations due to the retrospective design, further studies are needed to clarify these findings.

Highlights

Superficial temporal-to-middle cerebral artery (STA-MCA) anastomosis is a surgical treatment to reduce the risk of cerebral ischemia in patients with moyamoya disease (MMD) [1]
Consistent with these studies, our findings suggest that the risk of Transient neurological deficits (TND) after revascularization surgery for MMD might be associated with low intraoperative systolic blood pressure (ISBP), which might cause local intraoperative hypoperfusion
Systolic BP (SBP) of 125–133 should be considered as the target; our results showed that avoiding lower SBP during STA-MCA anastomosis among MMD patients was associated with decreased TND

Summary

Introduction

Superficial temporal-to-middle cerebral artery (STA-MCA) anastomosis is a surgical treatment to reduce the risk of cerebral ischemia in patients with moyamoya disease (MMD) [1]. In pediatric MMD patients undergoing STA-MCA anastomosis, decreased reserve capacity in postoperative SPECT was associated with neurological deficit and ischemic attacks [11]. Jung et al reported that hypotension was associated with an increased risk of ischemic stroke after surgical treatment in patients with MMD. These studies did not focus on the impact of perioperative BP on the risk of TND in these patients

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