Prediction of cerebral infarction after bypass surgery in adult moyamoya disease: combing parameters on 4D perfusion CT with clinical related factors

• Published in: Acta neurochirurgica 2024-11, Vol.166 (1), p.484
• Main Authors: Ding, Jiangbo, Chang, Xuying, Shen, Yong, Ma, Peiyu, Zhang, Ruoyu, Yang, Guangwu, Mu, Linjie, Zhang, Xingkui, Li, Zhigao, Tang, Jinwei, Tang, Zhiwei
• Format: Article
• Language: English
• Subjects: Adult; Anastomosis; Blood flow; Cerebral blood flow; Cerebral infarction; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - etiology; Cerebral Revascularization - adverse effects; Cerebral Revascularization - methods; Cerebrovascular Circulation - physiology; Female; Four-Dimensional Computed Tomography - methods; Heart surgery; Humans; Interventional Radiology; Ischemia; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Moyamoya disease; Moyamoya Disease - diagnostic imaging; Moyamoya Disease - surgery; Neurology; Neuroradiology; Neurosurgery; Patients; Perfusion; Perfusion Imaging - methods; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Predictive Value of Tests; Retrospective Studies; Risk factors; Statistical analysis; Stroke; Surgery; Surgical Orthopedics
• ISSN: 0001-6268; 0942-0940; 0942-0940
• DOI: 10.1007/s00701-024-06373-8

Objective This study aimed to identify predictive factors for cerebral infarction after bypass surgery in adult patients with moyamoya disease (MMD) using quantitative parameters in 4D-CT perfusion software. Methods A total of 108 patients who underwent combined revascularization, including superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-myo-synangiosis (EDMS), in our hospital between September 2019 and August 2023 were analyzed retrospectively. Preoperative relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time (rMTT), and relative time to maximum residual function (rTmax) perfusion parameters were obtained using 4D-CT perfusion software. These quantitative parameters, combined with related clinical and angiographic factors, were statistically analyzed using univariate and multivariate regression analyses to determine the significant predictors of cerebral infarction after bypass surgery. Results Acute cerebral infarction occurred in 12 patients postoperatively. Univariate analysis showed that a history of previous ischemic events ( P  = 0.024), higher Suzuki stage ( P  = 0.006), higher modified Rankin score (mRS) ( P  = 0.013), rCBV ( P  = 0.026), rMTT ( P  = 0.001), and rTmax ( P