Cerebral Ischemic Complications of Surgical Treatment in Patients with Moyamoya Disease.

OBJECTIVE

We aimed to identify unfavorable prognostic factors for the development of cerebral ischemic complications of surgical treatment in patients with moyamoya disease.

METHODS

We analyzed 80 patients with moyamoya disease, who underwent 134 surgical revascularizations. Persistent complications (ischemic strokes) developed in seven cases (5.3%). In 36 cases (27%), there were short-term episodes of transient neurologic deficit.

RESULTS

The statistical analysis revealed factors associated with the development of transient and persistent ischemic complications: neuroradiological "ivy sign" (χ2 = 4.078, p = 0.043), stenosis of the ICA proximal to the PComA or PCA (χ2 = 20.085, p < 0.0001), decompensation of cerebral blood flow (χ2 = 11.212, p < 0.001), recent CVA (less than 3 months before surgery) or instability of neurological symptoms (χ2 = 6.146, p < 0.013). Significant factors of the development of persistent ischemic stroke were as follows: stenosis or occlusion of the ipsilateral PCA (increasing the risk of stroke by 9.7 times); signs of the decompensation of cerebral perfusion (increased risk by 5.4 times); and unstable clinical symptoms within 3 months before surgery (increased risk by 6.4 times). The presence of at least two signs defines a group of patients that has an increased risk of complications with a sensitivity of 80.7% and a specificity of 88.6%.

CONCLUSION

The identified risk factors will enable predicting the risk of perioperative ischemic complications in patients with moyamoya disease and optimize management tactics and improve the results of surgical treatment.