Prediction of cerebral infarction after bypass surgery in adult moyamoya disease: using pulsatility index on TCD

• Published in: BMC neurology Vol. 24; no. 1; pp. 198 - 11
• Main Authors: Ding, Jiangbo, Chang, Xuying, Ma, Peiyu, Yang, Guangwu, Zhang, Ruoyu, Li, Yuanyuan, Lei, Ting, Mu, Linjie, Zhang, Xingkui, Li, Zhigao, Tang, Jinwei, Tang, Zhiwei
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.06.2024; BioMed Central; BMC
• Subjects: Adult; Adult moyamoya disease; Analysis; Anastomosis; Blood pressure; Care and treatment; Cerebral infarction; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - epidemiology; Cerebral Infarction - etiology; Cerebral Revascularization - adverse effects; Cerebral Revascularization - methods; Chi-square test; Complications; Complications and side effects; Coronary artery bypass; Diagnosis; Epilepsy; Female; Flow velocity; Humans; Hyperlipidemia; Hypertension; Infarction; Ischemia; Male; Medical imaging; Medical treatment; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - surgery; Moyamoya disease; Moyamoya Disease - diagnostic imaging; Moyamoya Disease - surgery; Multivariate analysis; Patients; Postoperative; Postoperative care; Postoperative Complications - diagnosis; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Pulsatile Flow - physiology; Retrospective Studies; Risk Factors; Stroke; Surgery; TCD; Transcranial Doppler ultrasonography; Ultrasonic imaging; Ultrasonography, Doppler, Transcranial - methods; Ultrasound; Veins & arteries; Young Adult; China; PI; Infarction; Adult moyamoya disease; TCD
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-024-03707-y

At present, the most effective treatment for symptomatic moyamoya disease (MMD) is surgery. However, the high incidence of postoperative complications is a serious problem plaguing the surgical treatment of MMD, especially the acute cerebral infarction. Decreased cerebrovascular reserve is an independent risk factor for ischemic infarction, and the pulsatility index (PI) of transcranial Doppler (TCD) is a common intuitive index for evaluating intracranial vascular compliance. However, the relationship between PI and the occurrence of ischemic stroke after operation is unclear. To explore whether the PI in the middle cerebral artery (MCA) could serve as a potential predictor for the occurrence of ischemic infarction after bypass surgery in MMD. We performed a retrospective analysis of data from 71 patients who underwent combined revascularization surgery, including superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-myo-synangiosis (EDMS). The patients were divided into two groups according to the median of ipsilateral MCA-PI before operation, low PI group (MCA-PI < 0.614) and high PI group (MCA-PI ≥ 0.614). Univariate and multivariate regression analysis were used to explore risk factors affecting the occurrence of postoperative cerebral infarction. Among the 71 patients with moyamoya disease, 11 patients had cerebral infarction within one week after revascularization. Among them, 10 patients' ipsilateral MCA-PI were less than 0.614, and another one's MCA- PI is higher than 0.614. Univariate analysis showed that the lower ipsilateral MCA-PI (0.448 ± 0.109 vs. 0.637 ± 0.124; P = 0.001) and higher Suzuki stage (P = 0.025) were linked to postoperative cerebral infarction. Multivariate analysis revealed that lower ipsilateral MCA-PI was an independent risk factor for predicting postoperative cerebral infarction (adjusted OR = 14.063; 95% CI = 6.265 ~ 37.308; P = 0.009). A lower PI in the ipsilateral MCA may predict the cerebral infarction after combined revascularization surgery with high specificity. And combined revascularization appears to be safer for the moyamoya patients in early stages.