Prediction of cerebral infarction after bypass surgery in adult moyamoya disease: using pulsatility index on TCD.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968555 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2377 (Electronic) Linking ISSN: 14712377 NLM ISO Abbreviation: BMC Neurol Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Moyamoya Disease*/surgery ; Moyamoya Disease*/diagnostic imaging ; Cerebral Infarction*/etiology ; Cerebral Infarction*/diagnostic imaging ; Cerebral Infarction*/epidemiology ; Cerebral Revascularization*/adverse effects ; Cerebral Revascularization*/methods ; Ultrasonography, Doppler, Transcranial*/methods ; Postoperative Complications*/epidemiology ; Postoperative Complications*/diagnosis ; Postoperative Complications*/etiology ; Postoperative Complications*/diagnostic imaging; Humans ; Male ; Female ; Adult ; Retrospective Studies ; Middle Aged ; Middle Cerebral Artery/diagnostic imaging ; Middle Cerebral Artery/surgery ; Pulsatile Flow/physiology ; Young Adult ; Risk Factors

Background: At present, the most effective treatment for symptomatic moyamoya disease (MMD) is surgery. However, the high incidence of postoperative complications is a serious problem plaguing the surgical treatment of MMD, especially the acute cerebral infarction. Decreased cerebrovascular reserve is an independent risk factor for ischemic infarction, and the pulsatility index (PI) of transcranial Doppler (TCD) is a common intuitive index for evaluating intracranial vascular compliance. However, the relationship between PI and the occurrence of ischemic stroke after operation is unclear.
Objective: To explore whether the PI in the middle cerebral artery (MCA) could serve as a potential predictor for the occurrence of ischemic infarction after bypass surgery in MMD.
Methods: We performed a retrospective analysis of data from 71 patients who underwent combined revascularization surgery, including superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-myo-synangiosis (EDMS). The patients were divided into two groups according to the median of ipsilateral MCA-PI before operation, low PI group (MCA-PI < 0.614) and high PI group (MCA-PI ≥ 0.614). Univariate and multivariate regression analysis were used to explore risk factors affecting the occurrence of postoperative cerebral infarction.
Results: Among the 71 patients with moyamoya disease, 11 patients had cerebral infarction within one week after revascularization. Among them, 10 patients' ipsilateral MCA-PI were less than 0.614, and another one's MCA- PI is higher than 0.614. Univariate analysis showed that the lower ipsilateral MCA-PI (0.448 ± 0.109 vs. 0.637 ± 0.124; P = 0.001) and higher Suzuki stage (P = 0.025) were linked to postoperative cerebral infarction. Multivariate analysis revealed that lower ipsilateral MCA-PI was an independent risk factor for predicting postoperative cerebral infarction (adjusted OR = 14.063; 95% CI = 6.265 ~ 37.308; P = 0.009).
Conclusions: A lower PI in the ipsilateral MCA may predict the cerebral infarction after combined revascularization surgery with high specificity. And combined revascularization appears to be safer for the moyamoya patients in early stages.
(© 2024. The Author(s).)

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ZX2019-03-05 Yunnan Clinical Medical Center of Nervous System Diseases; ZX2019-03-05 Yunnan Clinical Medical Center of Nervous System Diseases; ZX2019-03-05 Yunnan Clinical Medical Center of Nervous System Diseases; ZX2019-03-05 Yunnan Clinical Medical Center of Nervous System Diseases; ZX2019-03-05 Yunnan Clinical Medical Center of Nervous System Diseases; RLTZW20210629 Yunnan Province High Level Talent Training Support Program Young top talent Project; 2022535D04 535 Talent Project of First Affiliated Hospital of Kunming Medical University

Keywords: Adult moyamoya disease; Infarction; PI; TCD

Date Created: 20240612 Date Completed: 20240613 Latest Revision: 20240615

20240615

PMC11167940

10.1186/s12883-024-03707-y

38867178