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High variance of intraoperative blood pressure predicts early cerebral infarction after revascularization surgery in patients with Moyamoya disease

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Abstract

Few studies focused on the intraoperative blood pressure in Moyamoya disease (MMD) patients. We aimed to clarify whether or not it relates to early cerebral infarction after revascularization. We reviewed a retrospective cohort of Moyamoya disease from 2011 to 2018 in Beijing Tiantan Hospital, and patients with radiologically confirmed early postoperative infarction were included in the analysis. Controls were matched based on age, sex, and revascularization modality at a ratio of 1:5. Perioperative clinical factors and intraoperative blood pressure data were collected and analyzed. A total of 52 patients out of 1497 revascularization surgeries (3.5%) who experienced CT or MRI confirmed early postoperatively cerebral infarction, aged 38.46 ± 11.70; 26 were male (50.0%). Average real variability (ARV)-systolic blood pressure (SBP) (OR 3.29, p = 0.003), ARV-diastolic blood pressure (DBP) (OR 4.10, p = 0.005), ARV-mean arterial pressure (MAP) (OR 4.08, p = 0.004), and the maximum drops of DBP (OR 1.08, p = 0.003) and MAP (OR 1.06, p = 0.004) were associated with early postoperative infarction. In patients who experienced massive cerebral infarction, the maximum drops of DBP (OR 1.11, p = 0.004) and MAP (OR 1.11, p = 0.003) are independent risk factors, whereas ARVs of SBP (OR 3.90, p < 0.001), DBP (OR 4.69, p = 0.008), and MAP (OR 4.72, p = 0.003) are significantly associated with regional infarction. High variance of intraoperative blood pressure and drastic blood pressure decline are independent risk factors for postoperative infarction in MMD patients who underwent revascularization surgery. Maintaining stable intraoperative blood pressure is suggested to prevent early postoperative cerebral infarction in MMD patients.

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Funding

This study was funded by Beijing Municipal Administration of Hospitals’ Mission Plan (SML2015050) and the Program of the National Natural Science Foundation of China (81701137).

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China

    Jiaxi Li, Yahui Zhao, Meng Zhao, Penghui Cao, Xingju Liu, Dong Zhang, Yan Zhang, Rong Wang & Jizong Zhao

  2. China National Clinical Research Center for Neurological Diseases (NCRC-ND), No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China

    Jiaxi Li, Yahui Zhao, Meng Zhao, Penghui Cao, Xingju Liu, Dong Zhang, Yan Zhang, Rong Wang & Jizong Zhao

  3. Center of Stroke, Beijing Institute for Brain Disorders, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China

    Jiaxi Li, Yahui Zhao, Meng Zhao, Penghui Cao, Xingju Liu, Dong Zhang, Yan Zhang, Rong Wang & Jizong Zhao

  4. Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China

    Hao Ren

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  1. Jiaxi Li
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Correspondence to Jizong Zhao.

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The study was performed according to the guidelines of the Helsinki Declaration and was approved by the ethics committee of Beijing Tiantan Hospital.

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Li, J., Zhao, Y., Zhao, M. et al. High variance of intraoperative blood pressure predicts early cerebral infarction after revascularization surgery in patients with Moyamoya disease. Neurosurg Rev 43, 759–769 (2020). https://doi.org/10.1007/s10143-019-01118-z

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