Abstract

BACKGROUND: Perioperative management of blood pressure in patients undergoing surgical revascularization for moyamoya disease (MMD) remains a controversial topic. We evaluated the safety and efficacy of induced hypertension and hypervolemia (IHH) in preventing neurological complications during the perioperative period after direct surgical revascularization in a large hemorrhagic onset moyamoya disease (HOMMD) cohort.METHODS: We retrospectively reviewed a prospectively managed departmental database of all HOMMD patients treated between 1987 and 2019. One hundred and twenty-two direct surgical revascularization patients were included in the study. Patients were separated into groups, based on presence or absence of IHH therapy, and evaluated for occurrence of 30-day risk of transient neurologic events (TNEs), ischemic, and hemorrhagic complications.RESULTS: 203 revascularization procedures were performed on 122 patients for HOMMD treatment. Nineteen TNEs (9.4% of procedures) were observed in 18 (14.8%) patients. Two patients (1.6% and 1.0% of procedures) suffered from ischemic complications and one (0.8% and 0.5% of procedures) from hemorrhagic complications. No differences between groups in the severity, duration of TNEs, nor length of hospital stay were noted. No patient in the IHH therapy group experienced a recurring TNE or readmission after discharge; however, this was not statistically significant owing to the small sample size. There were no differences in the rates of ischemic or hemorrhagic complications between groups with or without IHH therapy (p=0.46 and 0.54 respectively).CONCLUSIONS: Induced hypertension and hypervolemia appears safe in HOMMD. There were no significant differences in complication or TNE rates between the groups with or without IHH therapy. While we believe it is important to employ IHH therapy in MMD patients who present with ischemic symptoms, these findings suggest that prophylactic IHH therapy may not be necessary in MMD patients presenting with hemorrhage.

View details for DOI 10.1016/j.wneu.2022.01.017

View details for PubMedID 35026459