Predictors of perioperative stroke in patients with Ischemic-type moyamoya disease treated with surgical revascularization: A retrospective multicenter study

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-03-07 DOI:10.1016/j.jstrokecerebrovasdis.2025.108277

Basel Musmar MD , Joanna M. Roy MD , Hammam Abdalrazeq MD , Elias Atallah MD , Kareem El Naamani MD , Ching-Jen Chen MD , Roland Jabre MD , Hassan Saad MD , Jonathan A. Grossberg MD , Adam A. Dmytriw MD, MPH, MSc , Aman B. Patel MD , Mirhojjat Khorasanizadeh MD , Christopher S Ogilvy MD , Ajith J. Thomas MD , Andre Monteiro MD , Adnan Siddiqui MD , Gustavo M. Cortez MD , Ricardo A. Hanel MD,PhD , Guilherme Porto MD , Alejandro M. Spiotta MD , Pascal Jabbour MD

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引用次数: 0

Abstract

Introduction

Moyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive stenosis or occlusion of the internal carotid arteries and the development of collateral moyamoya vessels. Surgical revascularization is commonly used to prevent future ischemic events in ischemic-type MMD, but there remains a high rate of stroke perioperatively. This study aims to analyze the predictive factors for perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization using a large multicenter database.

Methods

We conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. This study included patients with ischemic-type MMD who underwent surgical revascularization across 13 academic institutions in North America. Data were collected and analyzed on a per-hemisphere basis, covering patient demographics, disease characteristics, procedural details, and outcomes. Statistical analyses were performed using Stata (V.17.0), comparing baseline characteristics, and using univariable and multivariable logistic regression to identify predictors of perioperative stroke.

Results

A total of 301 patients with ischemic-type MMD underwent surgical revascularization, with 34 patients (11.3 %) experiencing perioperative stroke. Patients who experienced perioperative stroke had a mean age of 43.6 years (SD 14.0) compared to 40.0 years (SD 13.9) in those without perioperative stroke (P = 0.16). Hypertension was significantly more prevalent in the perioperative stroke group (73.5 % vs. 47.9 %, P = 0.005). Current smoking was also more common in the perioperative stroke group (55.8 % vs. 38.2 %, P = 0.04). Multivariate logistic regression identified hypertension (OR 2.32, 95 % CI 1.01 to 5.37, P = 0.04) and current smoking (OR 2.28, 95 % CI 1.04 to 4.97, P = 0.03) as significant independent predictors of perioperative stroke.

Conclusion

Hypertension and smoking were significant predictors of perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization. These findings emphasize the importance of managing risk factors in ischemic-type MMD. Further prospective studies are needed to validate these findings.

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手术血运重建术治疗缺血性烟雾病患者围手术期卒中的预测因素：一项回顾性多中心研究

烟雾病（Moyamoya disease， MMD）是一种以进行性颈内动脉狭窄或闭塞以及侧支烟雾血管发展为特征的慢性脑血管疾病。手术血运重建术通常用于预防缺血性烟雾病的未来缺血性事件，但围手术期卒中的发生率仍然很高。本研究旨在利用大型多中心数据库分析缺血性烟雾病患者行手术重建术围手术期卒中的预测因素。方法：我们按照加强流行病学观察性研究报告（STROBE）指南进行了一项多中心回顾性研究。本研究包括来自北美13个学术机构的接受手术血运重建术的缺血性烟雾病患者。收集和分析每个半球的数据，包括患者人口统计、疾病特征、手术细节和结果。使用Stata （V.17.0）进行统计分析，比较基线特征，并使用单变量和多变量logistic回归来确定围手术期卒中的预测因素。结果：301例缺血性烟雾病患者行手术血运重建术，其中34例（11.3%）发生围手术期卒中。围手术期卒中患者的平均年龄为43.6岁（SD 14.0），而非围手术期卒中患者的平均年龄为40.0岁（SD 13.9）（P=0.16）。围手术期卒中组高血压患病率更高（73.5%比47.9%，P=0.005）。在围手术期卒中组中，吸烟也更为常见（55.8%比38.2%，P=0.04）。多因素logistic回归发现高血压（OR 2.32, 95% CI 1.01 ~ 5.37， P=0.04）和当前吸烟（OR 2.28, 95% CI 1.04 ~ 4.97， P=0.03）是围手术期卒中的重要独立预测因素。结论：高血压和吸烟是缺血性烟雾病患者行外科血运重建术围手术期卒中的重要预测因素。这些发现强调了管理缺血性烟雾病危险因素的重要性。需要进一步的前瞻性研究来验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.