• Wonhyoung Park, Jae Sung Ahn, Hye Sun Lee, Jung Cheol Park, and Byung Duk Kwun.
• Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
• World Neurosurg. 2016 Aug 1; 92: 65-73.

ObjectiveIt 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.MethodsIschemic 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.ResultsThe 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).ConclusionsOur 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.Copyright © 2016 Elsevier Inc. All rights reserved.

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