Analysis of postoperative complications and influencing factors in patients with unstable moyamoya disease undergoing combined revascularization surgery
Objective To investigate the incidence of postoperative complications in patients with unstable moyamoya disease undergoing combined revascularization surgery and to analyze the associated risk factors.Methods A retrospective study was performed on 1 142 moyamoya disease patients who underwent combined revascularization surgery at the Department of Neurosurgery,Zhengzhou University People's Hospital(Henan Provincial People's Hospital)between January 2018 and December 2022.According to the inclusion criteria,the patients were divided into conventional moyamoya disease group and unstable moyamoya disease group,and the incidence of complications in the early postoperative period(within 14 days)of the two groups of patients was compared and analyzed.Patients with unstable moyamoya disease were further divided into postoperative complications group and no-complication group.The differences in clinical data between the two groups were compared.Multivariate logistic regression analysis was used to analyze the risk factors affecting early postoperative complications in patients with unstable moyamoya disease.P＜0.05 was considered as a statistically significant difference.Results Among the 1 142 patients,1 091 were in the conventional moyamoya disease group and 51 were in the unstable moyamoya disease group.The overall incidence rate of reversible ischemic neurological dysfunction(RIND),cerebral infarction,cerebral hemorrhage and epileptic seizure in the postoperative unstable moyamoya disease group was 41.2％(21 cases),which was higher than the 10.3％in the conventional moyamoya disease group(112 cases)(P＜0.001),among which the difference in the incidence of cerebral infarction was the most significant[29.4％(15/51)vs.1.0％(11/1 091),P＜0.001].Among patients with unstable moyamoya disease,compared with the postoperative no-complication group(30 cases),the complication group(21 cases)had higher proportions of patients with transient ischemic attack(TIA)as the initial preoperative symptom[57.1％(12/21)vs.23.3％(7/30)],with the degree of stenosis of the vessel on the stenotic side ≤50％[47.6％(10/21)vs.10.0％(3/30)],and with the occlusion test on the surgical side[90.5％(19/21)vs.50.0％(15/30)](all P＜0.05).Multivariate logistic regression analysis showed that TIA as the first preoperative symptoms TIA(OR=7.45,95％CI:1.25-44.50,P=0.028),degree of stenosis of the vessel on the stenotic side ≤50％(OR=14.88,95％CI:1.56-142.07,P=0.019),and occlusion on the stenotic side(OR=44.87,95％CI:3.16-636.88,P=0.005)were risk factors for complications after revascularization in patients with moyamoya disease.Conclusions Patients with unstable moyamoya disease are at high risk for perioperative complications following combined revascularization surgery.Key risk factors include vascular stenosis ≤50％on the stenotic side,occlusion on the operative side and initial symptoms of TIA.
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