Transient ischemic attack after indirect revascularization surgery for pediatric patients with moyamoya disease: A retrospective study of intraoperative blood pressure - 18/01/23
Highlights |
• | TIA had a relatively high recurrence rate in children with moyamoya disease. |
• | 16% of 444 hemispheres experienced postoperative TIA after revascularization. |
• | 7.7% of 444 hemispheres developed postoperative symptom progression. |
• | Higher baseline blood pressure was risk factor predicting postoperative TIA. |
• | High variability and drastic decline in MAP may predict symptom progression. |
Abstract |
Background |
This study aimed to investigate the association between intraoperative blood pressure and postoperative transient ischemic attacks (TIAs) in pediatric patients with moyamoya disease after indirect revascularization surgery.
Methods |
We retrospectively reviewed the medical records of patients with moyamoya disease younger than 15 years who underwent indirect revascularizations under general anesthesia from 2013 to 2019. Perioperative clinical factors and intraoperative blood pressure data were collected and analyzed. Univariate and multivariable mixed-effect logistic regressions were used to identify predictors of postoperative TIA and symptom progression.
Results |
Among 444 hemispheres in 296 pediatric patients, 70 cases (16%) experienced postoperative TIAs within 2 weeks after surgery, and 34 cases (7.7%) developed postoperative symptom progression. Baseline mean blood pressure (MBP) (adjusted odds ratio, 1.261; 95% confidence interval, 1.037−1.528; P < 0.001), Average mean arterial pressure (MAP) (adjusted odds ratio, 1.137; 95% confidence interval, 1.052−1.228; P = 0.006), and Ipsilateral magnetic resonance angiography (MRA) score (adjusted odds ratio, 1.464; 95% confidence interval, 0.886−2.419; P = 0.012) were statistically significant risk factors for postoperative TIA. Average real variability of MAP (ARV-MAP), which were measures of intraoperative MAP variability (adjusted odds ratio, 4.731; 95% confidence interval, 1.419−15.257; P = 0.003) and maximum MAP declination (MaxD-MAP) (adjusted odds ratio, 1.271; 95% confidence interval, 1.013−1.520; P = 0.010) were statistically significant risk factors for postoperative symptom progression.
Conclusion |
Higher pre-induction baseline blood pressure and ipsilateral MRA score were independent risk factors predicting postoperative TIA in pediatric patients with moyamoya disease after indirect revascularization. The high variability and drastic decline in intraoperative MAP showed predictive value in postoperative symptom progression.
Le texte complet de cet article est disponible en PDF.Keywords : Moyamoya disease, Transient ischemic attack, Intraoperative blood pressure, Pediatric, Risk factors
Plan
Vol 42 - N° 1
Article 101168- février 2023 Retour au numéro
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