title: Risk Factors for Newly Developed Cerebral Infarction After Surgical Revascularization for Adults with Moyamoya Disease.
abstract: OBJECTIVE
  It is important to recognize the incidence and risk factors for ischemic complications after surgical revascularization for moyamoya disease (MMD). However, most studies focus on pediatric MMD or pediatric and adult MMD. Our study identified the incidence and risk factors of newly developed cerebral infarction after surgical revascularization for adult MMD.
  
  
  METHODS
  Ischemic complications were defined as newly developed cerebral infarction within 15 days after surgery, as identified by imaging studies. To identify the incidence and these risk factors for adult patients ≥18 years, we retrospectively reviewed our experience with 194 adult MMD patients with 241 surgical revascularizations.
  
  
  RESULTS
  The incidence of symptomatic infarction after surgical revascularization was 5.8% (14 cases); 30 cases (12.4%) experienced a silent infarction. In univariate analysis, initial presentation as infarction, initial presentation as hemorrhage, transient ischemic attacks (TIAs) >3 times/month, involvement of the posterior cerebral artery (PCA), combined bypass, and using muscle for revascularization were variables related to the newly developed cerebral infarction. Multivariate analysis revealed that the following factors were independently associated with newly developed cerebral infarction after surgery: cerebral infarction as initial presentation (odds ratio [OR] 1.150; 95% confidence interval [CI] 1.038-1.273; P = 0.0073), TIAs >3times/month (OR 1.188; 95% CI 1.058-1.335; P = 0.0035), and PCA involvement (OR 1.095; 95% CI 1.005-1.194; P = 0.039).
  
  
  CONCLUSIONS
  Our findings demonstrate that newly developed, silent cerebral infarction developed more frequently than symptomatic cerebral infarction in adult patients. Cerebral infarction as initial presentation, frequent TIA before surgery, and PCA involvement were also independent risk factors for newly developed cerebral infarction after surgical revascularization for adult MMD.
authors.affiliation: Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Wonhyoung
authors.initials: W
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: jsahn@amc.seoul.kr.
authors.forename: Jae Sung
authors.initials: JS
authors.lastname: Ahn
authors.affiliation: Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Jung Cheol
authors.initials: JC
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Byung Duk
authors.initials: BD
authors.lastname: Kwun
mesh_terms: D000293:Adolescent; D000328:Adult; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D002548:Cerebral Revascularization / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D059906:Neuroimaging; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Adult; Cerebral infarction; Cerebral revascularization; Moyamoya disease; Perioperative period