Analysis Of Risk Factors For New Cerebral Infarction After Extracranial-intracranial Vascular Bypass For Occlusive Cerebrovascular Disease

Background:Extracranial-intracranial(EC-IC)vascular bypass surgery is a surgical method to improve the blood supply of brain tissue,using extracranial healthy arterial blood vessels to anastomosing blood vessels lacking blood supply in the brain.This procedure is commonly used in the treatment of occlusive cerebrovascular diseases such as Moyamoya disease(MMD),atherosclerotic intracranial large vessel stenosis /occlusion and intracranial aneurysms.Unlike surgical treatment of MMD,can this procedure be used to treat atherosclerotic intracranial large vessel stenosis / occlusion such as the internal carotid artery(ICA)intracranial segment or middle cerebral artery(middle cerebral artery,MCA)Stenosis / occlusion is currently controversial.It has been found in clinical work that some patients with occlusive cerebrovascular disease have poor results after receiving medical treatment,and there are still frequent transient ischemic attacks(TIA),and even cerebral infarction,and these patients have undergone EC-IC Vascular bypass surgery directly improves the blood supply of brain tissue,thereby benefiting.Although the operation method is very mature at present and the symptom improvement rate of postoperative patients is also high,there are still a certain proportion of complications after EC-IC vascular bypass treatment,such as hyperperfusion syndrome,cerebral infarction,TIA,scalp Poor wound healing,etc.,cerebral infarction seriously affect the prognosis of patients,and even lead to death.This study aimed to explore the risk factors of EC-IC vascular bypass for the treatment of new cerebral infarction after occlusive cerebrovascular disease,and put forward corresponding preventive measures in order to reduce the probability of new cerebral infarction after EC-IC vascular bypass.Objective:To explore the risk factors of EC-IC vascular bypass in the treatment of new cerebral infarction after occlusive cerebrovascular surgery,and to refer to the relevant literature and clinical work to put forward corresponding preventive measures inorder to reduce the incidence of new cerebral infarction after EC-IC vascular bypass.Methods:This study retrospectively analyzed 572 patients with MMD undergoing EC-IC vascular bypass surgery and 62 patients with ICA intracranial or MCA stenosis /occlusion during the period from January 2014 to September 2019 in the First Affiliated Hospital of Nanchang University.According to whether or not cerebral infarction occurred during the perioperative period,it was divided into positive group and negative group.Univariate and multivariate analysis were conducted on the clinical data of the two groups of patients,including age,sex,underlying disease complication,surgical method,and whether aspirin was used after surgery,to find out the risk of new cerebral infarction after EC-IC vascular bypass Factors and further explore the corresponding preventive measures.Results:1.The incidence of cerebral infarction during perioperative period after vascular bypass in MMD patients is 5.42%(31/572).Univariate analysis showed that: in the positive group and the negative group,the age,mean systolic blood pressure before surgery,history of hypertension and diabetes,MMD type,posterior cerebral artery(PCA)stenosis / occlusion,acute cerebral infarction before surgery,frequent TIA within one month before operation,and aspirin not used after operation were statistically significant(P <0.05).Multivariate logistic regression analysis showed that the independent risk factors of new cerebral infarction after vascular bypass in MMD patients are: infarct MMD,history of hypertension,combined PCA stenosis /occlusion,left vascular bypass,acute cerebral infarction and TIA occurred frequently within one month before surgery,and aspirin was not used after surgery(P <0.05).2.The incidence of cerebral infarction in patients with atherosclerotic intracranial large-vessel stenosis / occlusion after vascular bypass surgery is 12.9%(8/62).Univariate analysis showed that the positive and negative groups had statistically significant differences in mean systolic blood pressure before surgery,history of hypertension and no aspirin after surgery(P <0.05).Multivariate logistic regression analysis showed that preoperative systolic blood pressure was too high and aspirinwas not used after surgery as an independent risk factor for new cerebral infarction after vascular bypass in patients with atherosclerotic intracranial large vessel stenosis/ occlusion(p <0.05).Conclusion:1.The independent risk factors for new cerebral infarction after vascular bypass in MMD patients are: infarct MMD,patient with history of hypertension,combined PCA stenosis / occlusion,left vascular bypass,acute cerebral infarction before surgery,one TIA occurred frequently during the month and aspirin was not used after surgery.2.High preoperative systolic blood pressure and no aspirin after surgery are independent risk factors for new cerebral infarction after vascular bypass in patients with atherosclerotic intracranial large vessel stenosis/occlusion.