Clinical prognosis of adult moyamoya disease patients after direct bypass surgery

Abstract

Abstract Background This study aimed to identify the factors affecting the patency of the bridging vessels and the improvement of postoperative neurological function, so as to enable the prediction of the influence on vascular bypass before operation and to guide the selection of surgical strategies. Methods We used Logistic regression analysis to determine if the following factors were related to the patency of the bypass: age, sex, smoking history, drinking, diabetes, hypertension, history of pre-operation cerebral infarction, transient ischemic attack (TIA), clinical classification of moyamoya disease (MMD), clinical manifestations, preoperative modified Rankin Scale mRS score, and Suzuki staging (operative side, non-operative side, and posterior circulation involvement). Base on this, we can explore the related factors affecting the vascular patency and prognosis. The symptom improvement data at discharge, 6 months after discharge and 2 years after discharge after bypass surgery in adult patients with MMD disease through outpatient or telephone follow-up were collected. The postoperative neurological function through mRS score was evaluated. After that, the linear mixed effect model was used to analyze the effects of related factors on the changes of mRS score. Results There is a significant difference between hypertension history and indirect bridging angiogenesis in the grade of direct bridging angiogenesis (P < 0.05). Logistic regression analysis further confirmed that hypertension (OR:0.24, 95% CI: 0.10–0.56) was a risk factor affecting direct bridge angiogenesis after operation. Compared with grade 0 of direct bridge vessels, grade II vascular patency was related to the decrease of indirect angiogenesis (OR:0.14, 95% CI:0.03–0.64), but the results of trend test showed that indirect bridge angiogenesis decreased with the increase of grade (P = 0.030). The follow-up data (250 cases) were processed by linear mixed effect model. The study found that despite the risk of intracranial hemorrhage in patients with hyperperfusion, the neurological function recovered relatively quickly; The neurological function of patients with cerebral infarction after operation is generally poor, but the recovery speed is relatively fast, and the prognosis is still worse than that of patients without cerebral infarction. Conclusions Patients with hypertension are prone to direct bridge vascular occlusion after operation; Direct bridge angiogenesis after operation is better, which will inhibit indirect bridge angiogenesis. Patients with high perfusion after operation have large blood flow. Although they have the risk of bleeding, their neurological function recovers relatively quickly; Although the recovery rate of patients with postoperative cerebral infarction is relatively fast, the prognosis is still poor.