Risk factors analysis of complications after cerebrovascular bypass in patients with moyamoya disease

Abstract

Objective To analyze the relationship between the preoperative relative blood glucose ratio and the safety of cerebrovascular bypass of ischemic moyamoya disease (MMD) patients. Methods A total of 178 patients with ischemic MMD who were hospitalized in Department of Neurosurgery of Qilu Hospital of Shandong University from December 2016 to December 2019. A total of 186 cases underwent superficial temporal artery⁃middle cerebral artery (STA⁃MCA) bypass. The fasting blood glucose and glycated albumin of all patients at admission were recorded to calculate the relative blood glucose ratio. After STA⁃MCA bypass, the incidence of postoperative complications was counted. Univariate and multivariate Logistic regression were used to analyze the risk factors of postoperative complications of ischemic MMD. Results 186 cases were divided into 4 groups based on relative blood glucose ratio, Q1＜0.404, Q2 0.404-, Q3 0.456-, Q4≥0.534. The proportion of right surgery side in Q1 group was higher than that in Q3 group (χ²=4.762, P=0.029) and Q4 group (χ²=22.087, P=0.000), while the proportion of right surgery side in Q2 group (χ²=16.331, P=0.000) and Q3 group (χ²=7.355, P=0.007) was higher than that in Q4 group. The incidence of mild complications in Q1 group (χ²=6.389, P=0.011) and Q2 group (χ²=4.040, P=0.044) was higher than that in Q4 group. The incidence of postoperative complications was 28.49% (53/186), of which 8.60% (16/186) were severe type and 19.89% (37/186) were mild type, including transient neurological dysfunction 97.30% (36/37), subdural hemorrhage 2.70% (1/37). Logistic regression analysis showed that the relative blood glucose ratio increased (OR=1.484, 95%CI: 1.071-2.058; P=0.018), hypertension (OR=3.696, 95%CI: 1.805-7.569; P=0.000), operative interval＜2 months (OR=2.186, 95%CI: 1.041-4.590; P=0.039) was risk factors for postoperative complications. Conclusions In order to reduce the incidence of postoperative complications in patients with ischemic MMD, the operation interval after infarction can be extended to 2 months, and the preoperative relative blood glucose ratio should be closely monitored and the perioperative blood pressure should be controlled.

doi：10.3969/j.issn.1672⁃6731.2022.05.009