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

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 ( = 457) and a validation set ( = 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;  = 0.004), posterior cerebral artery anomalies (OR 2.106, 95% CI 1.157-3.834;  = 0.015), post-transit arterial development (OR 2.983, 95% CI 1.336-6.661;  = 0.008), pre-anesthesia mean arterial pressure > 102.830 mmHg (OR 3.329, 95% CI 1.938-5.721;  < 0.001), total operating time > 212.500 min (OR 2.256, 95% CI 1.239-4.140;  = 0.008), preoperative fibrinogen level > 2.750 g/L (OR 1.852, 95% CI 1.072-3.200;  = 0.027), and mean corpuscular hemoglobin concentration (OR 1.021, 95% CI 1.001-1.040;  = 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.

Clinical Trial Registration: www.chictr.org, identifier ChiCTR2400087946.