Correlation Analysis Of Relative Hyperglycemia And Operation Time Of Patients With Ischemic Moyamoya Disease And Cerebrovascular Complications After Direct Bypass Surgery

Objective:To study the relationship between relative hyperglycemia(preoperative fasting blood glucose divided by the average blood glucose in the past 2-4 weeks)and the safety of direct bypass surgery of ischemic moyamoya patients,and explore safe surgery time.Methods:1.We retrospectively analyzed the clinical data of ischemic moyamoya disease patients who received direct superficial temporal artery-middle cerebral artery(STA-MCA)bypass surgery from December 2016 to December 2019.Inclusion criteria:(1)Moyamoya disease was confirmed by preoperative cerebral angiography(DSA);(2)Preoperative MRI confirmed the presence of cerebral infarction and DWI showed no new high brightness infarction;(3)The operation interval after infarction was longer than 1 month;(4)All patients underwent superficial temporal artery middle cerebral artery bypass grafting,and the patients without direct bypass grafting were excluded.2.Fasting blood glucose and glycated albumin(GA)were collected before operation,Fasting blood glucose/GA was used to respond to relative hyperglycemia,Cerebral infarction was recorded by MRI,and Suzuki grade of moyamoya disease was recorded by cerebral angiography.The cerebrovascular complications during postoperative hospitalization were collected,including postoperative cerebral infarction,subdural hematoma and transient neurological dysfunction.Multivariate logistic regression analysis verified the relationship between relative hyperglycemia and operation time and postoperative cerebrovascular complications of moyamoya disease.Results:A total of 178 patients received 186 bypass surgeries,including 53 postoperative complications,including 16 severe complications,all of which were symptomatic cerebral infarction,37 cases of mild complications,36 cases of which were transient neurological dysfunction and 1 case subdural hemorrhage.Multivariate Logistic regression analysis showed that relative hyperglycemia(OR=1.484;95%CI:1.071-2.058;P=0.018),operative time<2months(OR=2.186;95%CI:1.041-4.590;P=0.014)and hypertension(OR=3.696;95%CI:1.805-7.569;P<0.001)were risk factors for cerebrovascular complications after moyamoya disease direct bypass surgery.Conclusion:1.We found that direct STA-MCA bypass of ischemic moyamoya patients had better safety when performed 2 months after ischemic stroke and at a low glucose/GA ratio.2.Effective control of blood pressure can reduce the incidence of cerebrovascular complications after ischemic moyamoya disease direct bypass.