Objective: To investigate the angioarchitectural factors associated with postoperative cerebral infarction in ischemic moyamoya disease.
Methods: Data on patients who underwent surgery for ischemic MMD from 1 October 2015 to 31 October 2020, at Peking University International Hospital were collected and retrospectively analyzed. General conditions such as patient sex, age, site of surgery, preoperative manifestations such as TIA attack and old cerebral infarction, and seven angioarchitectural factors of the MMD based on DSA were selected and measured. Statistical analysis was performed by the Pearson chi-square statistic, analysis of variance (ANOVA), and multifactor logistic regression analysis.
Results: Age (OR, 0.969; 95%CI, 0.939-1.000; p = 0.049), A1stenosis (OR, 5.843; 95%CI, 1.730-19.732; p = 0.004), M1stenosis (OR, 6.206; 95%CI, 2.079-18.526; p = 0.001), PCA anomalies (OR, 4.367; 95%CI, 1.452-13.129; p = 0.049), Unstable compensation (OR, 5.335; 95%CI, 1.427-19.948; p = 0.013), TIA (OR, 4.264; 95%CI, 1.844-9.863; p = 0.001), Old cerebral infarction (OR, 2.972; 95%CI, 1.194-7.397; p = 0.019). The above seven factors can be used in the regression equation to predict the probability of postoperative cerebral infarction. The prediction accuracy is 90.2%.
Conclusions: Age, TIA attack, old cerebral infarction, and five angioarchitectural factors of MMD are strongly associated with postoperative cerebral infarction. Seven factors, including age, TIA attack, old infarction, and four angioarchitectural factors, can be taken to quantify the probability of surgical cerebral infarction in MMD.
Keywords: DSA; angioarchitectural factor; direct and indirect revascularization; moyamoya disease; postoperative cerebral infarction.