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Risk Factors for Preoperative Cerebral Infarction in Infants with Moyamoya Disease

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Abstract

There have been few reports on the risk factors for preoperative cerebral infarction in childhood moyamoya disease (MMD) in infants under 4 years. The aim of this retrospective study is to identify clinical and radiological risk factors for preoperative cerebral infarction in infants under 4 years old with MMD, and the optimal timing for EDAS was also considered. We retrospectively analyzed the risk factors for preoperative cerebral infarction, confirmed by magnetic resonance angiography (MRA), in pediatric patients aged ˂4 years who underwent encephaloduroarteriosynangiosis between April 2005 and July 2022. The clinical and radiological outcomes were determined by two independent reviewers. In addition, potential risk factors for preoperative cerebral infarction, including infarctions at diagnosis and while awaiting surgery, were analyzed using a univariate model and multivariate logistic regression to identify independent predictors of preoperative cerebral infarction. A total of 160 hemispheres from 83 patients aged <4 years with MMD were included in this study. The mean age of all surgical hemispheres at diagnosis was 2.17±0.831 years (range 0.380–3.81 years). In the multivariate logistic regression model, we included all variables with P<0.1 in the univariate analysis. The multivariate logistic regression analysis indicated that preoperative MRA grade (odds ratio [OR], 2.05 [95% confidence interval [CI], 1.3–3.25], P=0. 002), and age at diagnosis (OR, 0.61 [95% CI, 0.4–0.92], P=0. 018) were predictive factors of infarction at diagnosis. The analysis further indicated that the onset of infarction (OR, 0.01 [95% CI, 0–0.08], P<0.001), preoperative MRA grade (OR, 1.7 [95% CI, 1.03–2.8], P=0.037), and duration from diagnosis to surgery (Diag-Op) (OR, 1.25 [95% CI, 1.11–1.41], P<0.001) were predictive factors for infarction while awaiting surgery. Moreover, the regression analysis indicated that family history (OR, 8.88 [95% CI, 0.91–86.83], P=0.06), preoperative MRA grade (OR, 8.72 [95% CI, 3.44–22.07], P<0.001), age at diagnosis (OR, 0.36 [95% CI, 0.14–0.91], P=0.031), and Diag-Op (OR, 1.38 [95% CI, 1.14–1.67], P=0.001) were predictive factors for total infarction. Therefore, during the entire treatment process, careful observation, adequate risk factor management, and optimal operation time are required to prevent preoperative cerebral infarction, particularly in pediatric patients with a family history, higher preoperative MRA grade, duration from diagnosis to operation longer than 3.53 months, and aged ˂3 years at diagnosis.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank the individuals who contributed to the study or manuscript preparation but did not fulfill all the criteria of authorship.

Funding

This study was supported by grants from the National Natural Science Foundation of China (grant numbers 82171280 and 82201451).

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  1. Qingbao Guo, Songtao Pei, and Qian-Nan Wang contributed equally to this work.

Authors and Affiliations

  1. Medical School of Chinese PLA, Beijing, China

    Qingbao Guo, Jingjie Li, Simeng Liu, Xiaopeng Wang, Fangbin Hao, Gan Gao & Minjie Wang

  2. Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China

    Qingbao Guo, Jingjie Li, Simeng Liu, Xiaopeng Wang, Fangbin Hao, Gan Gao, Minjie Wang & Lian Duan

  3. Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China

    Songtao Pei, Cong Han, Dan Yu, Qian Zhang, Zhengxing Zou, Jie Feng, Rimiao Yang, Heguan Fu & Xiangyang Bao

  4. Department of Neurosurgery, the Eighth Medical Centre, Chinese PLA General Hospital, Beijing, China

    Qian-Nan Wang

  5. Beijing Garrison Haidian 13th Retired Cadre Rest House, Beijing, China

    Feiyan Du

Authors
  1. Qingbao Guo
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Qingbao Guo, Songtao Pei, Qian-Nan Wang, Jingjie Li, Cong Han，Simeng Liu, Xiaopeng Wang, Dan Yu, Fangbin Hao, Gan Gao, and Qian Zhang. The first draft of the manuscript was written by Zhengxing Zou, Jie Feng, Rimiao Yang, Minjie Wang, Heguan Fu, Feiyan Du, Xiangyang Bao, and Lian Duan and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Xiangyang Bao or Lian Duan.

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Ethics Approval

This study was approved by the Ethics Committee of the Fifth Medical Center of the PLA General Hospital and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

Written informed consent was obtained by each member involved in this study from a parent or guardian of each infant.

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The authors declare no competing interests.

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Guo, Q., Pei, S., Wang, QN. et al. Risk Factors for Preoperative Cerebral Infarction in Infants with Moyamoya Disease. Transl. Stroke Res. (2023). https://doi.org/10.1007/s12975-023-01167-z

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