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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1537755
This article is part of the Research Topic Quality of Stroke Care: What Could Be Improved, and How? - Volume II View all 5 articles

A nomogram to predict postoperative new-onset cerebral infarction after revascularization of moyamoya disease in adults and its validation: a retrospective study

Provisionally accepted
Zhen Wang Zhen Wang 1*Jiacheng Yu Jiacheng Yu 2*Yu Zhang Yu Zhang 2*Jiaping Ruan Jiaping Ruan 2*Xiaojie Liu Xiaojie Liu 2*Sijia Ma Sijia Ma 2*Jun Xie Jun Xie 3*Mimi Wu Mimi Wu 2*Jinhua Bo Jinhua Bo 2*Yu’e Sun Yu’e Sun 1,2*
  • 1 Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
  • 2 Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
  • 3 Department of Anesthesiology, Chongqing General Hospital, Chongqing, Chongqing, China

The final, formatted version of the article will be published soon.

    Background: The new-onset cerebral infarction is frequent after revascularization of moyamoya disease (MMD) in adults, serving as a major public health issue worldwide. The present study aims to construct a nomogram to predict postoperative new-onset cerebral infarction (POCI) after revascularization of adult MMD. Materials and Methods: Clinical data of 653 cases of adult MMD treated with revascularization were retrospectively analyzed. They were randomly divided into a training set (n=457) and a validation set (n=196) at a ratio of 7:3. Based on the risk factors of POCI after revascularization of adult MMD identified by logistic regression analysis and the corresponding regression coefficients, a nomogram was constructed. Its performance to predict POCI after revascularization of adult MMD was validated by calculating the area under the curve (AUC) and the decision curve analysis. Results: Univariate and multivariate logistic regression analyses showed that preoperative cerebral infarction (OR 2.548, 95% CI 1.357-4.787; P=0.004), posterior cerebral artery anomalies (OR 2.106, 95% CI 1.157-3.834; P=0.015), post-transit arterial development (OR 2.983, 95% CI 1.336-6.661; P=0.008), pre-anesthesia mean arterial pressure >102.830 mmHg (OR 3.329, 95% CI 1.938-5.721; P<0.001), total operating time > 212.500 min (OR 2.256, 95% CI 1.239-4.140; P=0.008), preoperative fibrinogen level>2.750 g/L (OR 1.852, 95% CI 1.072-3.200; P=0.027), and mean corpuscular hemoglobin concentration (OR 1.021, 95% CI 1.001-1.040; P=0.038) were independent risk factors of POCI after revascularization of adult MMD. The AUC was 0.772 (95% CI 0.714-0.772) in the training set, and 0.718 (95% CI 0.603-0.833) in the validation set. Conclusion: Collectively, the newly established nomogram effectively and intuitively predicts the POCI after revascularization of adult MMD.

    Keywords: Adult moyamoya disease, Revascularization, postoperative new-onset cerebral infarction, nomogram, Retrospective study

    Received: 01 Dec 2024; Accepted: 06 Jan 2025.

    Copyright: © 2025 Wang, Yu, Zhang, Ruan, Liu, Ma, Xie, Wu, Bo and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Zhen Wang, Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
    Jiacheng Yu, Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
    Yu Zhang, Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
    Jiaping Ruan, Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
    Xiaojie Liu, Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
    Sijia Ma, Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
    Jun Xie, Department of Anesthesiology, Chongqing General Hospital, Chongqing, 400081, Chongqing, China
    Mimi Wu, Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
    Jinhua Bo, Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
    Yu’e Sun, Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China

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