Clinical significance of postoperative collateral circulation formation in long-term prognosis and stroke events after EDAS in adults with moyamoya disease.

Postoperative collateral formation (PCF) in patients with moyamoya disease (MMD) who underwent Encephaloduroarteriosynangiosis (EDAS) is often used as an index to evaluate the effectiveness of surgery. However, it has not been studied whether PCF can predict long-term outcomes in MMD patients. Our study aimed to determine the relationship between PCF and long-term prognosis and stroke events in adult patients with MMD. The authors reviewed 246 hemispheres of 123 patients who underwent EDAS surgery at our hospital between January 2017 and December 2018. Multivariate logistic regression analysis showed that poor PCF (OR 4.094, 95%CI 1.032-16.239, p = 0.045), mRS score of ≥ 3 at admission (OR 131.713, 95%CI 15.264-1136.523, p < 0.001), smoking (OR 7.453, 1.541-36.057, P = 0.013) and age (OR 1.156, 95%CI 1.059-1.262, p = 0.001) were independent risk factors for poor prognosis. According to Kaplan-Meier analysis, the incidence of stroke in the poor PCF group was higher than that in the good group (p = 0.001). Cox regression analysis showed that age (OR 1.061, 95%CI 1.001-1.124; p = 0.046), hypertension (OR 3.842, 95%CI 1.011-14.605; p = 0.048), mRS ≥ 3 at admission (OR 3.318, 95%CI 1.098-10.027; p = 0.033) and poor PCF (OR 3.242, 95%CI 1.060-9.916; p = 0.039) were positive predictors of stroke incidence. PCF reliably reflects the long-term prognosis and stroke events after EDAS in adults with MMD. Good PCF is associated with a better long-term prognosis and a lower incidence of stroke. This study provides evidence supporting PCF as an imaging indicator to predict long-term outcomes in adult patients with moyamoya disease after EDAS.