Cerebral Ischemic Complications After Surgical Revascularization for Moyamoya Disease: Risk Factors and Development of a Predictive Model Based on Preoperative Nutritional Blood Parameters

Abstract

ObjectivesCerebral ischemic complications are common after revascularization in patients with moyamoya disease (MMD). Risk factors from specific laboratory variables have only been assessed by limited research. This study was to investigate the association between postoperative cerebral ischemia and nutritional blood parameters and examine predictive values of such risk factors in adults.MethodsPreoperative demographics and nutritional blood parameters of patients with MMD who received revascularization at our institution from 2012 to 2021 were retrospectively reviewed. Univariate analysis and multivariable logistic regression were used to identify independent risk factors for the onset of postoperative cerebral ischemic complications. Predictive values were tested and a model incorporating these independent risk factors was created using the R program. Area under the receiver operating characteristic curve (AUC) was used for testing its discriminability.ResultsPostoperative cerebral ischemic complications occurred in 32 patients of 100 included procedures. Surgery on the left hemisphere, lower admission modified Rankin Scale (mRS) score, aberrant nutritional parameters including low white blood cell (WBC), and high total cholesterol (TC) were significantly associated with cerebral ischemic complications after revascularization. The intriguing role of WBC might be explained by altered immunomodulation. The AUC of this model with novel nutritional parameters yielded a value of 0.811, presenting better predictive accuracy. Additionally, the model was visualized in the form of a nomogram and translated into a user-friendly calculator to generate individual risk.ConclusionsSurgical side, admission mRS score, WBC, and TC were independent risk factors for postoperative cerebral ischemic complications. The model composed of these four parameters was promising to be adopted in clinical practice.

Postoperative cerebral infarction after revascularization in patients with moyamoya disease: Incidence and risk factors

“…Consistent with the findings of a previous study, our findings indicate that revascularization procedures conducted on the left hemisphere are more likely to result in postoperative cerebral infarction ( 23 ). Surgery conducted in the dominant hemisphere is more likely to cause systemic symptoms such as aphasia, cognitive loss, and affective disorders, as well as heart rate and blood pressure variations.…”

Clinical Features and Risk Factors of Postoperative Stroke in Adult Moyamoya Disease

“…Overall, the findings from this comparative study provide valuable insights into potential predictors for postoperative stroke in patients with MMD. While risk factors for postoperative stroke have been explored in multiple retrospective studies [12,13,18,19], the precise underlying cause of postoperative hemorrhage and ischemia remains elusive. In the current study, MMD patients with preoperative hemorrhage were found to be more likely to have PHS than patients from the control group.…”

“…Although surgical revascularization effectively regulated blood flow in the impaired hemisphere, subsequent hyperfusion, vulnerable MMD vessels, and micro-aneurysms also had potential to occur, which posed potential risks for postoperative rebleeding. Furthermore, MMD patients presenting with hemorrhagic symptoms might have more fragile perforating arteries [19], thereby increasing the likelihood of postoperative hemorrhage following blood flow disruption [23].…”