Abstract WP37: Predictors of Perioperative Stroke in Patients with Ischemic-type Moyamoya Disease Treated with Surgical Revascularization: A retrospective multicenter study

• DOI: 10.1161/str.56.suppl_1.wp37
• Publication Date: 2025-01-30T10:18:44Z
• Authors: Basel Musmar; Joanna Roy; Hammam Abdalrazeq; Elias Atallah; Kareem El Naamani; jared chen; Roland Jabre; Hassan Saad; Jonathan Grossberg; Adam Dmytriw; Aman Patel; Mirhojjat Khorasa...; Christopher Ogilvy; Ajith Thomas; Andre Monteiro; Adnan Siddiqui; Gustavo Cortez; Ricardo Hanel; Guilherme Porto; Alejandro Spiotta; Anthony J. Piscopo; David Hasan; Mohammad Ghorbani; Joshua Weinberg; Shahid Nimjee; Kimon Bekelis; Mohamed Salem; Jan-Karl Burkhardt; Akli Zetchi; Charles Matouk; Brian Howard; Pui Man Rosalind Lai; Rose Du; Rawad Abbas; Georgios S Sioutas; Abdelaziz Amllay; Alfredo Munoz; Nabeel Herial; Stavropoula Tjoum...; Michael Gooch; Robert Rosenwasser; Pascal Jabbour

Introduction: Moyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive stenosis or occlusion of the internal carotid arteries and the development of collateral moyamoya vessels. Surgical revascularization is commonly used to prevent future ischemic events in ischemic-type MMD, but there remains a high rate of stroke perioperatively. This study aims to analyze the predictive factors for perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization using a large multicenter database.

Methods: We conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. This study included patients with ischemic-type MMD who underwent surgical revascularization across 13 academic institutions in North America. Data were collected and analyzed on a per-hemisphere basis, covering patient demographics, disease characteristics, procedural details, and outcomes. Statistical analyses were performed using Stata (V.17.0), comparing baseline characteristics, and using univariable and multivariable logistic regression to identify predictors of perioperative stroke.

Results: A total of 301 patients with ischemic-type MMD underwent surgical revascularization, with 34 patients (11.3%) experiencing perioperative stroke. Patients who experienced perioperative stroke had a mean age of 43.6 years (SD 14.0) compared to 40.0 years (SD 13.9) in those without perioperative stroke (P=0.16). Hypertension was significantly more prevalent in the perioperative stroke group (73.5% vs. 47.9%, P=0.005). Smoking was also more common in the perioperative stroke group (55.8% vs. 38.2%, P=0.04). Multivariate logistic regression identified hypertension as a significant independent predictor of perioperative stroke (OR 2.4, 95% CI 1.06 to 5.45, P=0.03).

Conclusion: Hypertension is a significant predictor of perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization. Further prospective studies are needed to validate these findings.