Abstract T MP59: Symptomatic and Silent Cerebral Infarct following Combined Bypass for Moyamoya Disease evaluated with Diffusion-Weighted Image: A Multivariate Analysis
Background: The clinical features of cerebral infarct detected by diffusion-weighted image (DWI) following combined direct and indirect bypass for moyamoya disease (MMD) is still not fully understood. This study aims to study the incidence and risk correlates of symptomatic and silent cerebral infarct following combined bypass in MMD.
Methods: A retrospective survey was conducted with a sample size of 95 consecutive patients with MMD treated by combined bypass in Hokkaido University since 2002. DWI that was evaluated within 2 weeks after surgery was available in 111 of 131 surgeries (85%). Demographics, preoperative radiological findings, procedure-related data and postoperative symptomatic hyperperfusion were assessed. A multivariate logistic regression analysis was used to study the related variables on postoperative cerebral infarct on DWI.
Results: Postoperative DWI detected a total of 21 instances (18.9%/surgery) of cerebral infarct, with no significant difference between generations (21.9 and 13.2%/surgery in adults and pediatrics, respectively). Symptomatic and silent cerebral infarct was occurred more frequently when surgery was performed following the ischemic events within 6 months prior to the surgery (recent ischemic events) compared to when performed without the recent ones (15.3 and 3.6%/surgery, respectively, P = 0.0078). Preemptive antiplatelet use and procedure-related variables, including craniotomy size and the number of direct bypass did not have any relationships with cerebral infarct. After adjustment of above-mentioned variables, symptomatic and silent cerebral infarct was found to associate significantly with recent ischemic events (P = 0.032; OR = 5.5; 95%CI 1.2-26) and preoperative FLAIR ivy sign (P = 0.047; OR = 5.9; 95%CI 1.02-33.9). Cerebral infarct detected by DWI was likely to be observed beyond the area covered by combined bypass.
Conclusions: Symptomatic and silent cerebral infarct occurred in 18.9% of combined bypasses for MMD. It may be associated with recent ischemic events and preoperative FLAIR ivy sign. Surgical management to avoid postoperative infarct after the combined bypass beyond the bypassed area would be essential to further improve the outcome of ischemic type of MMD.
Author Disclosures: K. Tokairin: None. M. Ito: None. K. Kazumata: None. S. Kaneko: None. K. Houkin: None.
- © 2015 by American Heart Association, Inc.