A nomogram to predict postoperative new-onset cerebral infarction after revascularization of moyamoya disease in adults and its validation: a retrospective study.

BACKGROUND

The new-onset cerebral infarction is frequent after revascularization of moyamoya disease (MMD) in adults, serving as a major public health issue worldwide. The present study aims to construct a nomogram to predict postoperative new-onset cerebral infarction (POCI) after revascularization of adult MMD.

MATERIALS AND

METHODS

Clinical data of 653 cases of adult MMD treated with revascularization were retrospectively analyzed. They were randomly divided into a training set (n = 457) and a validation set (n = 196) at a ratio of 7:3. Based on the risk factors of POCI after revascularization of adult MMD identified by logistic regression analysis and the corresponding regression coefficients, a nomogram was constructed. Its performance to predict POCI after revascularization of adult MMD was validated by calculating the area under the curve (AUC) and the decision curve analysis.

RESULTS

Univariate and multivariate logistic regression analyses showed that preoperative cerebral infarction (OR 2.548, 95% CI 1.357-4.787; p = 0.004), posterior cerebral artery anomalies (OR 2.106, 95% CI 1.157-3.834; p = 0.015), post-transit arterial development (OR 2.983, 95% CI 1.336-6.661; p = 0.008), pre-anesthesia mean arterial pressure > 102.830 mmHg (OR 3.329, 95% CI 1.938-5.721; p < 0.001), total operating time > 212.500 min (OR 2.256, 95% CI 1.239-4.140; p = 0.008), preoperative fibrinogen level > 2.750 g/L (OR 1.852, 95% CI 1.072-3.200; p = 0.027), and mean corpuscular hemoglobin concentration (OR 1.021, 95% CI 1.001-1.040; p = 0.038) were independent risk factors of POCI after revascularization of adult MMD. The AUC was 0.772 (95% CI 0.714-0.772) in the training set, and 0.718 (95% CI 0.603-0.833) in the validation set.

CONCLUSION

Collectively, the newly established nomogram effectively and intuitively predicts the POCI after revascularization of adult MMD.

CLINICAL TRIAL REGISTRATION: www.chictr.org, identifier ChiCTR2400087946.