Preoperative platelet count may predict postoperative symptomatic cerebral hyperperfusion syndrome after superficial temporal artery–middle cerebral artery anastomosis in moyamoya patients

• Published in: Clinical neurology and neurosurgery Vol. 199; p. 106260
• Main Authors: Jo, Woo-Young, Oh, Hyongmin, Kim, Heewon, Yoon, Hyun-Kyu, Lee, Hyung-Chul, Cho, Won-Sang, Kim, Jeong-Eun, Park, Hee-Pyoung
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2020; Elsevier Limited
• Subjects: Anastomosis; Anesthesia; Blood; Blood platelets; Blood pressure; C-reactive protein; Demography; Dysarthria; Hematoma; Hemoglobin; Hospitals; Inflammation; Laboratories; Magnetic resonance imaging; Microvasculature; Moyamoya disease; Neurology; Oxidative stress; Pathophysiology; Patients; Platelet; Platelets; Postoperative cerebral hyperperfusion syndrome; Statistical analysis; Superficial temporal artery-middle cerebral artery anastomosis; Surgery; Veins & arteries; Platelet; Moyamoya disease; Postoperative cerebral hyperperfusion syndrome; Superficial temporal artery-middle cerebral artery anastomosis
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2020.106260

•STA-MCA anastomosis is a surgical treatment option in moyamoya patients.•Postoperative symptomatic cerebral hyperperfusion syndrome (PSCHS) is a complication.•Preoperative platelet count was a significant predictor of PSCHS after STA-MCA anastomosis. Platelets play a critical role in the inflammatory response, accompanied by microvascular endothelial dysfunction, underlying postoperative symptomatic cerebral hyperperfusion syndrome (PSCHS) after superficial temporal artery–middle cerebral artery (STA-MCA) anastomosis in moyamoya patients. We examined whether the preoperative platelet count can predict PSCHS after STA-MCA anastomosis in such patients. In 160 adult moyamoya patients undergoing 186 STA-MCA anastomoses, preoperative (demographics, initial clinical manifestation, and Suzuki grade), intraoperative (surgical time, operative side, fluid balance, and maximum and minimum mean blood pressure before and after vessel anastomosis), immediate postoperative (APACHE 2 score), and laboratory (hemoglobin and C-reactive protein levels and white blood cell and platelet counts) data were collected retrospectively. 84 patients (90 sides, 48.4 %) developed PSCHS with a median(IQR) onset of postoperative day 1(0–3) and duration of 4(3–7) days. The preoperative (25.2[22.8–28.0] vs. 23.1[19.7–26.2] ×104/μL, p = 0.009) platelet count was significantly higher in patients with PSCHS than in those without. The preoperative platelet count (odds ratio[95 % confidence interval], 1.14[1.03–1.27], p = 0.011), operation on the dominant hemisphere (6.84 [3.26–14.36], p < 0.001), and negative fluid balance (2.41[1.04–5.59], p = 0.040) were significant independent predictors of PSCHS. The optimal cut-off value for preoperative platelet count was 22.7 ×104/μL, and PSCHS developed more frequently in cases with a preoperative platelet count ≥ 22.7 × 104/μL (2.90[1.54–5.45]; p = 0.001). A high preoperative platelet count may be associated with the development of PSCHS after STA-MCA anastomosis in adult moyamoya patients.