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Postoperative stroke and neurological outcomes in the early phase after revascularization surgeries for moyamoya disease: an age-stratified comparative analysis

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Abstract

Stroke and neurological outcomes in the early phase following revascularization for moyamoya disease (MMD) may depend on the patient’s age. In this study, an age-stratified comparative analysis was performed to clarify this issue. We reviewed 105 MMD patients who underwent 179 revascularization surgeries. The demographic characteristics were collected in four age groups (≤ 5 and 6–17 years for pediatric patients and 18–49 and ≥ 50 years for adults). Additionally, we assessed the incidence of subsequent stroke and deterioration of modified Rankin Scale (mRS) score. Then, we evaluated predictors of postoperative stroke and mRS deterioration using logistic regression. The mean patient age was 26.2 ± 18.5 years. No significant difference in the incidence of postoperative stroke was observed between age groups; however, the incidence tended to be increased among patients aged ≤ 5 years (17.9%) and patients aged ≥ 50 years (16.7%). Deterioration of mRS scores was significantly associated with ages ≤ 5 years (17.9%) and ≥ 50 years (11.1%). Logistic regression showed that posterior cerebral artery involvement (odds ratio [OR], 4.6) and postoperative transient neurological events (TNEs) (OR, 5.93) were risk factors for postoperative stroke. Age ≤ 5 years (OR, 9.73), postoperative TNEs (OR, 7.38), and postoperative stroke (OR, 49) were identified as predictors of unfavorable neurological outcomes. The novel feature of this comparative analysis by age group is that membership in the early-childhood MMD patient group (under 5 years old) was an independent risk factor for unfavorable short-term neurological outcomes and was mainly associated with the incidence of postoperative severe cerebral infarction.

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The data and materials that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This work was funded by a grant from the Japan Society for the Promotion of Science to Yoshio Araki (No. 7118 K08967, https://www.jsps.go.jp).

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Authors and Affiliations

  1. Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, Japan

    Yoshio Araki, Kinya Yokoyama, Kenji Uda, Fumiaki Kanamori, Michihiro Kurimoto, Yoshiki Shiba, Takashi Mamiya, Masahiro Nishihori, Takashi Izumi, Toshihiko Wakabayashi & Atsushi Natsume

  2. Department of Neurosurgery, Toyota Kosei Hospital, 500-1 Ibobara, Josui-cho, Toyota City, Aichi, Japan

    Masaki Sumitomo

  3. Aichi Rehabilitation Hospital, 1-1 Nishigara, Ehara Town, Nishio City, Aichi, Japan

    Sho Okamoto

  4. Department of Biostatistics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, Japan

    Kota Matsui, Ryo Emoto & Shigeyuki Matsui

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  1. Yoshio Araki
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  2. Kinya Yokoyama
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  3. Kenji Uda
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Contributions

All authors read and approved the final manuscript. Conception and design: YA and MK. Data acquisition: YA, KY, KU, FK, YS, and TM. Drafting the article: YA. Statistical analysis: KM, RE, and SM. Critical revision and advice: MN, TI, MS, SO, and TW. Supervision: AN.

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Correspondence to Yoshio Araki.

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This study has been approved by the Bioethics Review Committee of Nagoya University Hospital (2016-0327).

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Araki, Y., Yokoyama, K., Uda, K. et al. Postoperative stroke and neurological outcomes in the early phase after revascularization surgeries for moyamoya disease: an age-stratified comparative analysis. Neurosurg Rev 44, 2785–2795 (2021). https://doi.org/10.1007/s10143-020-01459-0

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