Abstract
Objective To evaluate whether hemodynamic factors are risk factors for prognosis in moyamoya disease (MMD). Materials and Methods The retrospective study reviewed a single-center MMD cohort in Huashan Hospital from August 2017 to January 2020. Stroke events in 30 days and follow-up modified Rankin Scale (mRS) grade were recorded. Systematic assessments with perioperative mean arterial pressure (MAP), red blood cell (RBC) parameters, and fluid management were also conducted. Logistic regressions were applied to evaluate the predictors of worse outcomes. Data was analyzed using SPSS 24.0. Results Admission to neurological intensive care unit (NICU) totalled about 347 after revascularization surgery. The result showed that the higher the postoperative MAP level (favorable group 95.7 ± 11.4 mmHg vs. unfavorable group 103.6 ± 10.4 mmHg, p < 0.001) and the greater the MAP variability (favorable group 0.26 ± 13.2 vs. unfavorable group 7.2 ± 13.5, p = 0.006) were, the higher the patient's follow-up mRS grade was. What is more, a higher early postoperative Hb level also seemed to predict a worse long-term clinical outcome (favorable group 116.9 ± 17.1 g/L vs. unfavorable group 123.7 ± 13.0 g/L, p = 0.03), but the difference disappeared after adjusting sex and age. Logistic regression analyses showed that a higher level of postoperative MAP (β = 0.024, 95% CI (0.004, 0.044), and p = 0.02) within the first 24 h in NICU might be the short-term risk factor. For long-term outcome, a higher level (β = 1.058, 95% CI (1.022, 1.096), and p = 0.001) and a greater variability (β = 30.982, 95% CI (2.112, 454.414), and p = 0.01) of postoperative MAP might be the negative predictors of mRS grade. Conclusions The early postoperative hemodynamic management might be extremely critical for patients with MMD. Both high postoperative MAP levels and large MAP variability might affect the prognosis. What is more, we also found that a higher postoperative Hb level might be related with a worse outcome.
Highlights
Moyamoya disease (MMD) is characterized by the formation of an abnormal vascular network at the base of the brain, which could result in hemodynamic compromise significant different from normocapnia [1, 2]
Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis with or without indirect bypass is generally used as the standard surgical treatment for MMD [1, 2, 6,7,8]
The inclusion criteria were as follows: (1) age between 18 and 80 years; (2) MMD or moyamoya syndrome confirmed by digital subtraction angiography (DSA); (3) patients who underwent revascularization surgery; (4) after operations, patients were monitored in neurological intensive care unit (NICU) for at least 24 hours; (5) patients who were followed up for more than six months; and (6) patients with complete information and follow-up data
Summary
Moyamoya disease (MMD) is characterized by the formation of an abnormal vascular network at the base of the brain, which could result in hemodynamic compromise significant different from normocapnia [1, 2]. The type of anesthetic drug, fluid resuscitation, blood loss and hematocrit (Hct), end tidal carbon dioxide (EtCO2), temperature regulation, urine output, and the type of surgical procedure being done may affect cerebral blood flow and cerebral perfusion pressure [8, 12,13,14]. Under these conditions, inadequate cerebral perfusion may augment the risk for the occurrence of cerebral infarctions in MMD with
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