Postoperative Symptomatic Cerebral Infarction in Pediatric Moyamoya Disease: Risk Factors and Clinical Outcome

2020 ◽  
Vol 136 ◽  
pp. e158-e164 ◽  
Author(s):  
Jung Won Choi ◽  
Sangjoon Chong ◽  
Ji Hoon Phi ◽  
Ji Yeoun Lee ◽  
Hee-Soo Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Cerebral Infarction ◽  
Moyamoya Disease ◽  
Disease Risk

Postoperative hemorrhage during the acute phase after direct or combined revascularization for moyamoya disease: risk factors, prognosis, and literature review

2020 ◽  
Vol 133 (5) ◽  
pp. 1450-1459
Author(s):  
Yu Chen ◽  
Li Ma ◽  
Junlin Lu ◽  
Xiaolin Chen ◽  
Xun Ye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Phase ◽  
Moyamoya Disease ◽  
Disease Risk ◽  
Propensity Score Analysis ◽  
Postoperative Hemorrhage ◽  
Posterior Circulation ◽  
Short Term ◽  
Significant Difference

OBJECTIVEPostoperative hemorrhage during the acute phase is rarely observed after revascularization surgery for moyamoya disease (MMD) but can have severe complications. Its risk factors and outcomes are still unclear. The aim of this study was to investigate the predictors of postoperative hemorrhage during the acute phase in MMD and examine the outcomes of the hemorrhage.METHODSThe authors reviewed the preoperative clinical characteristics and radiographic features of 465 consecutive MMD cases (518 procedures) that had undergone direct or combined bypass surgery at their institution between 2009 and 2015. Patients with postoperative intracerebral hemorrhage (ICH) or ICH plus intraventricular hemorrhage (IVH) during the acute phase were screened, and then the incidence, location, and risk factors of hemorrhage in these patients were analyzed. Short-term and long-term outcomes (modified Rankin Scale scores) for these patients were also collected. Outcomes were compared between patients with and those without postoperative ICH using propensity score analysis to reduce the between-group differences in baseline characteristics.RESULTSPostoperative hemorrhage occurred in 11 (2.1%; ICH = 9, IVH = 2) of 518 procedures (mean patient age 39.82 ± 8.8 years). Hemorrhage occurred in the first 24 hours after the operation in 8 cases (72.7%). In the ICH group, most of the hemorrhage sites (77.8%) were located beneath the anastomosed area, and the mean hematoma volume was 16.98 ± 22.45 ml (range 3–57 ml). One case from the ICH group required hematoma evacuation. Among the adult patients (463 procedures [89.4%]), preoperative hypertension (p = 0.008), CT perfusion (CTP) stage > III (p = 0.013), and posterior circulation involvement (p = 0.022) were significantly associated with postoperative ICH. No significant differences between the postoperative ICH group and the no-hemorrhage group were detected in terms of postoperative neurofunctional status at discharge (p = 0.569) or at the last follow-up (p = 1.000). Neither was there a significant difference in future stroke risk (p = 0.538) between these two groups.CONCLUSIONSPreoperative hypertension, CTP stage > III, and posterior circulation involvement are independent risk factors for postoperative ICH after direct or combined revascularization for MMD. After appropriate perioperative management, postoperative ICH has no significant correlations with the postoperative short-term and long-term neurofunctional status.

Postoperative Cerebral Infarction Risk Factors and Postoperative Management of Pediatric Patients with Moyamoya Disease

2018 ◽  
Vol 113 ◽  
pp. e190-e199 ◽  
Author(s):  
Shinsuke Muraoka ◽  
Yoshio Araki ◽  
Goro Kondo ◽  
Michihiro Kurimoto ◽  
Yoshiki Shiba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Infarction ◽  
Moyamoya Disease ◽  
Pediatric Patients ◽  
Postoperative Management

Risk factors for cerebral infarction early after revascularization in children younger than 5 years of age with moyamoya disease

2022 ◽  
Author(s):  
Yoshio Araki ◽  
Kenji Uda ◽  
Kinya Yokoyama ◽  
Fumiaki Kanamori ◽  
Michihiro Kurimoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Infarction ◽  
Moyamoya Disease

Analysis of Factors Related to Cerebral Infarction after Direct Bypass Surgery in Adults with Moyamoya Disease

2020 ◽  
Vol 49 (1) ◽  
pp. 55-61
Author(s):  
Yun Qian ◽  
Bin Huang ◽  
Zongmin Hu ◽  
Jian Wang ◽  
Peng Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Infarction ◽  
Clinical Data ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Clinical Manifestations ◽  
History Of ◽  
Direct Bypass ◽  
Nonoperative Side

Objective: High-risk factors of the patients with moyamoya disease (MMD) were analyzed to provide the basis for prediction and management of cerebral infarction after direct bypass surgery in adult MMD. Methods: 1. Retrospective analysis of clinical data was collected from adult MMD patients (n = 250) following superficial temporal artery-middle cerebral artery bypass surgery performed in our hospital from July 2013 to December 2017. Of the 250 patients, all underwent hemispherical bypass surgery, and bilateral surgery was performed on 14 patients. 2. Clinical data were analyzed based on sex, age, hypertension, diabetes, smoking history, history of alcohol use, presurgery cerebral infarction, transient ischemic attack, classification of clinical manifestations, clinical typing, Suzuki stage of surgical side, Suzuki stage of nonoperative side, preoperative Modified Rankin Scale (MRS), and lesions of the postoperative cycle or not. Results: 1. There were significant differences in classification of clinical manifestations, preoperative infarction, clinical typing, and Suzuki stage of nonoperative side (p < 0.05). 2. Logistic regression analysis showed that the independent factors affecting postoperative cerebral infarction were preoperative infarction and the Suzuki stage of nonoperative side (p < 0.05). The preoperative infarction (B 1.431, OR 4.184, 95% CI 1.217–14.382) and the Suzuki stage of nonoperative side (B 0.495, OR 1.640, 95% CI 1.207–2.227) were both risk factors. Conclusion: The possibility of a new cerebral infarction in postoperative patients with a history of cerebral infarction was greater. The Suzuki stages (I–VI) of the nonoperative side was higher and associated with an increased probability of cerebral infarction after surgery.

scholarly journals Risk Factors for Early Seizure After Revascularization in Patients With Moyamoya Disease

2021 ◽  
Author(s):  
Hongchuan Niu ◽  
Cunxin Tan ◽  
Kehan Jin ◽  
Ran Duan ◽  
Guangchao Shi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cerebral Infarction ◽  
Moyamoya Disease ◽  
Logistic Regression Analysis ◽  
History Of ◽  
Independent Risk Factors ◽  
Postoperative Seizure ◽  
Early Seizure

Abstract Background To investigate the risk factors of early seizure after revascularization in patients with moyamoya disease (MMD). Methods A total of 298 patients with MMD diagnosed in our hospital from 2015 to 2018 were analyzed retrospectively. We summarized the characteristics of seizure after revascularization in patients with MMD and analyzed the predictors of early postoperative seizure. Results We identified 15 patients with MMD who developed seizures within 1 week after revascularization. According to logistic regression analysis, age (OR:1.04, 95% CI 0.998–1.086; P = 0.060), and infarct side (OR:1.92, 95% CI 0.856–4.290; P = 0.113) were not significantly associated with incident early seizure. Postoperative infarction (OR:12.89, 95% CI 4.198–39.525; P = 0.000) and preoperative cerebral infarction (OR:4.08, 95% CI 1.267–13.119; P = 0.018) were confirmed as risk factors for early seizure. Conclusions We believe that history of preoperative infarction and new infarction are independent risk factors of early seizure in patients with MMD after revascularization.

Risk Factors for Newly Developed Cerebral Infarction After Surgical Revascularization for Adults with Moyamoya Disease

2016 ◽  
Vol 92 ◽  
pp. 65-73 ◽  
Author(s):  
Wonhyoung Park ◽  
Jae Sung Ahn ◽  
Hye Sun Lee ◽  
Jung Cheol Park ◽  
Byung Duk Kwun
Keyword(s):  
Risk Factors ◽  
Cerebral Infarction ◽  
Moyamoya Disease ◽  
Surgical Revascularization

Ischemic complications following surgical treatment of moyamoya disease: risk factors and prevention

2021 ◽  
Vol 85 (6) ◽  
pp. 26
Author(s):  
V.A. Lukshin ◽  
A.A. Shulgina ◽  
D.Yu. Usachev ◽  
A.E. Korshunov ◽  
O.B. Belousova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Moyamoya Disease ◽  
Disease Risk ◽  
Ischemic Complications

scholarly journals Preoperative Risks of Cerebral Infarction in Pediatric Moyamoya Disease

Stroke ◽  
2021 ◽  
Author(s):  
Toshiaki Hayashi ◽  
Tomomi Kimiwada ◽  
Hiroshi Karibe ◽  
Reizo Shirane ◽  
Tatsuya Sasaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Infarction ◽  
Moyamoya Disease ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Significant Risk Factor ◽  
Age At Diagnosis ◽  
Optimal Timing ◽  
Potential Risk Factors

Background and Purpose: In pediatric moyamoya disease, there have been few reports of the risk factors for preoperative cerebral infarction, especially during the waiting period before surgery. The clinical and radiological findings of surgically treated pediatric moyamoya patients were evaluated to analyze the risk factors for cerebral infarction seen from onset to surgery. Methods: Between August 2003 and September 2019, 120 hemispheres of 71 patients under 18 years of age with moyamoya disease were surgically treated by direct and indirect bypass procedures. The mean age of all surgical hemispheres at diagnosis was 6.7±3.9 years (6 months–17 years). The potential risk factors for preoperative infarction were examined statistically. Results: Multivariate logistic regression analysis showed that risk factors for infarction at the time of diagnosis were age at diagnosis (odds ratio [OR], 0.68 [95% CI, 0.57–0.82]; P <0.0001) and the magnetic resonance angiography (MRA) score (OR, 2.29 [95% CI, 1.40–3.75]; P =0.001). Univariate analysis showed that risk factors for infarction while waiting for surgery were age at diagnosis (OR, 0.61 [95% CI, 0.46–0.80]; P <0.0001), the MRA score (OR, 1.75 [95% CI, 1.26–2.41]; P =0.0003), and onset of infarction (OR, 40.4 [95% CI, 5.08–322.3]; P <0.0001). Multiple comparisons showed that patients under 4 years of age were at a significantly high risk of infarction at the time of diagnosis and while waiting for surgery. Time from diagnosis to surgery of >2 months was a significant risk factor for infarction while waiting for surgery in patients under 6 years of age. Conclusions: Young age at diagnosis and a high MRA score may be associated with rapid disease progression and result in preoperative infarction. We recommend that surgery be performed within 2 months of diagnosis for the patients under 4 years of age with a high MRA score (>5) and cerebral infarction. Further study is needed to define the optimal timing of surgery.

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