Preoperative Risks of Cerebral Infarction in Pediatric Moyamoya Disease
| Autor: | Tomomi Kimiwada, Teiji Tominaga, Tatsuya Sasaki, Hirohito Metoki, Hiroshi Karibe, Toshiaki Hayashi, Reizo Shirane |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Single Photon Emission Computed Tomography Computed Tomography Adolescent Infarction Logistic regression 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Risk Factors Preoperative Care Medicine Humans In patient Moyamoya disease Child Retrospective Studies Advanced and Specialized Nursing business.industry Cerebral infarction Infant Odds ratio Cerebral Infarction medicine.disease Young age Radiological weapon Child Preschool Female Neurology (clinical) Moyamoya Disease Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery Magnetic Resonance Angiography |
| Zdroj: | Stroke. 52(7) |
| ISSN: | 1524-4628 |
| Popis: | Background and Purpose: In pediatric moyamoya disease, there have been few reports of the risk factors for preoperative cerebral infarction, especially during the waiting period before surgery. The clinical and radiological findings of surgically treated pediatric moyamoya patients were evaluated to analyze the risk factors for cerebral infarction seen from onset to surgery. Methods: Between August 2003 and September 2019, 120 hemispheres of 71 patients under 18 years of age with moyamoya disease were surgically treated by direct and indirect bypass procedures. The mean age of all surgical hemispheres at diagnosis was 6.7±3.9 years (6 months–17 years). The potential risk factors for preoperative infarction were examined statistically. Results: Multivariate logistic regression analysis showed that risk factors for infarction at the time of diagnosis were age at diagnosis (odds ratio [OR], 0.68 [95% CI, 0.57–0.82]; P P =0.001). Univariate analysis showed that risk factors for infarction while waiting for surgery were age at diagnosis (OR, 0.61 [95% CI, 0.46–0.80]; P P =0.0003), and onset of infarction (OR, 40.4 [95% CI, 5.08–322.3]; P 2 months was a significant risk factor for infarction while waiting for surgery in patients under 6 years of age. Conclusions: Young age at diagnosis and a high MRA score may be associated with rapid disease progression and result in preoperative infarction. We recommend that surgery be performed within 2 months of diagnosis for the patients under 4 years of age with a high MRA score (>5) and cerebral infarction. Further study is needed to define the optimal timing of surgery. |
| Databáze: | OpenAIRE |
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