Severe stenosis of major intracranial arteries: an important risk factor for infarction complications after combined revascularization in adult patients with ischemic moyamoya disease

BACKGROUND: Revascularization is the main effective treatment for moyamoya disease Moyamoya disease (MMD) but is associated with a high risk of postoperative cerebral infarction. We aimed to analyze the correlation between lesions in intracranial major arteries and postoperative cerebral infarction. METHODS: Adult patients with ischemic MMD were enrolled in this analysis from June 1, 2021, to October 31, 2024. The preoperative clinical characteristics and features of digital subtraction angiography were recorded. Postoperative computed tomography or magnetic resonance imaging was performed to identify infarction complications. The Suzuki stage and lesions of the intracranial major arteries were analyzed to determine their correlations with postoperative cerebral infarction. RESULTS: A total of 119 adult patients with ischemic moyamoya disease were included in the final analysis. When the degree of stenosis was considered a disordered variable and the normal artery was taken as the reference, the logistic regression analysis showed that severe stenosis of the internal carotid artery (ICA), anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) was significantly correlated with postoperative infarction (ICA (OR, 8.833; 95% CI, 0.730-106.821; p = 0.046), ACA (OR, 49.500; 95% CI, 5.083-482.011; p = 0.001), MCA (OR, 24.000; 95% CI, 1.459 - 394.881; p = 0.026), and PCA (OR, 54.333; 95% CI, 4.307-685.462; p = 0.002)). Digital subtraction angiography (DSA) was performed on three patients with postoperative cerebral infarction and showed acute occlusion or aggravated stenosis of the major intracranial arteries with severe preoperative stenosis. CONCLUSIONS: Severe stenosis of major intracranial arteries is an important risk factor for cerebral infarction after combined revascularization in adult patients with ischemic MMD.