Individualized Perioperative Blood Pressure Management For Adult Moyamoya Disease

Background: In adult patients with moyamoya disease(MMD)underwent combined revascularization,cerebral infarction and Hyperperfusion syndrome during the acute postoperative phase are common and can lead to neurological dysfunction after revascularization in MMD patients.The aim of this study was to explore the effect of individualized perioperative blood pressure management for adult MMD patients.Methods: We retrospectively reviewed 144 adult patients with MMD who underwent186 procedures of combined revascularization at our institution from March 2013 to June 2019.Clinical features and outcomes were analyzed,in particular regarding cerebral infarction and hyperperfusion syndrome(HPS)within 14 days after revascularization.All of the patients received individualized management perioperatively,especially about the blood pressure management according to the characteristics of moyamoya disease.Results: Cerebral infarction occurred in four(2.1%)procedures among four patients.No patients suffered from a malignant cerebral infarction and only one patient had permanent neurological deficits.The incidence of HPS was 10.8%,and no one presented with intracranial hemorrhage.All of the symptoms were reversible without any brain parenchymal injury.Conclusions: Our findings suggest that we can decrease the incidence and extent of cerebral infarction in adult MMD patients following combined revascularization by individualized perioperative BP management.