Reduction of systemic hypertension following cerebral revascularization surgery for children with moyamoya.

OBJECTIVE

The aim of this study was to evaluate whether indirect revascularization is associated with a reduction in systemic blood pressure (BP) over time in pediatric patients with moyamoya.

METHODS

This is a retrospective cohort study of pediatric patients with moyamoya who were treated at a single institution between June 2019 and January 2025. BP measurements were collected preoperatively (preadmission clinic evaluation) and postoperatively (outpatient follow-up evaluation at ≥ 3 months). BP was categorized as hypertensive or normotensive based on percentile thresholds adjusted for age, sex, and height, with measurements at the 95th and 99th percentiles indicating hypertension. The chi-square test was used to assess changes in hypertensive classification, and the paired t-test was used to compare mean absolute BP values at the two time points.

RESULTS

Overall, 63 children (39 female, mean age 11 years) with moyamoya who underwent indirect revascularization surgery were included in this analysis. The mean follow-up duration was 20.8 months. Preoperatively, 21 patients (33.9%) were classified as hypertensive for systolic BP and 9 (14.5%) for diastolic BP. These measurements were acquired preoperatively at a mean of 3.5 months (range 1 day to 11 months). Postoperatively, the proportion of hypertensive patients decreased to 10 (16.1%) and 3 (4.8%) for systolic BP and diastolic BP (p = 0.02 and 0.06, respectively). There was no significant change between the preoperative and postoperative mean arterial pressure measurements (77.3 mm Hg vs 76.2 mm Hg, respectively; p = 0.52).

CONCLUSIONS

Indirect revascularization surgery in pediatric patients with moyamoya was associated with a reduction in hypertension over time. This might reflect the delayed physiological effect of indirect revascularization, in which neovascularization and improved cerebral perfusion typically develop 3-6 months after surgery. Understanding BP changes following surgery might help avoid unnecessary use of antihypertensive drugs, which carry risk of precipitating hypotension and thus stroke.