Risk factors for postoperative ischemic complications in pediatric moyamoya disease

Xiaofeng Deng,Dong Zhang,Rong Wang,Jizong Zhao,Peicong Ge,Yan Zhang

doi:10.1186/s12883-021-02283-9

Abstract

BackgroundIschemic events are the most common postoperative complication in bypass surgery for moyamoya disease (MMD), but the risk factors for pediatric MMD remain unclear. The goal of the study was to investigate the risk factors for postoperative ischemic complications in pediatric MMD patients.MethodsWe retrospectively reviewed a consecutive series of pediatric MMD cases at Beijing Tiantan Hospital, Capital Medical University from June 2010 through June 2019. Preoperative clinical variables and radiographic findings were recorded, and logistic regression analysis was carried out to identify the risk factors for postoperative ischemic events.ResultsA total of 533 operations in 336 patients were included in this study. Postoperative complications occurred after 51 operations (9.6%), including 40/447 indirect bypass procedures, 9/70 direct bypass procedures, and 2/16 combined bypass procedures. Postoperative ischemic events were the most common complication and occurred in 30 patients after 31 procedures (8.9% per patient; 5.8% per operation), including 26/447 indirect bypass procedures, 4/70 direct bypass procedures, and 1/16 combined bypass procedures, and the incidence of these events did not differ significantly between indirect and non-indirect bypass (5.8% vs 5.8%; p = 0.999). Multivariate logistic regression analyses revealed that older age at operation (OR 1.129, 95% CI 1.011–1.260, p = 0.032) and posterior cerebral artery involvement (OR 2.587, 95% CI 1.030–6.496, p = 0.043) were significantly associated with postoperative ischemic events.ConclusionWe speculate that older age at operation and posterior cerebral artery involvement are risk factors for postoperative ischemic events in pediatric MMD patients.

Highlights

Moyamoya disease (MMD) is an uncommon chronic cerebrovascular occlusive disorder [1]
It has been reported that postoperative complications in surgical revascularization for moyamoya disease (MMD) occur in 5.6–20.5% of patients
The patient inclusion criteria were as follows: 1) patients diagnosed with MMD, based on digital subtraction angiography (DSA) and/or MR angiography according to the published guidelines of the Research Committee on MMD in Japan [9]; 2) patients who received surgical revascularization; and 3) patients aged less than 18 years old at the time of operation

Summary

Introduction

Moyamoya disease (MMD) is an uncommon chronic cerebrovascular occlusive disorder [1]. It is characterized by progressive stenosis or occlusion in the bilateral internal carotid arteries (ICAs) or their main branches with compensatory small arterial collaterals that appear as a “puff of smoke” on angiographic findings [2]. Revascularization surgery is the primary treatment for MMD; it prevents recurrent stroke and improves the prognosis, especially in the pediatric population [4]. Ischemic events are the most common postoperative complication in bypass surgery for moyamoya disease (MMD), but the risk factors for pediatric MMD remain unclear. The goal of the study was to investigate the risk factors for postoperative ischemic complications in pediatric MMD patients

Objectives

Methods

Results

Discussion

Conclusion