1045. Clinical profiles and risk factors of postoperative intracerebral hemorrhage after revascularization surgery in moyamoya disease

Authors: Kikutaro Tokairin, MD; Ken Kazumata; Haruto Uchino; Masaki Ito; Kiyohiro Houkin (Sapporo, Japan)

Introduction: In combined revascularization surgery for patients with moyamoya disease (MMD), intracerebral hemorrhage (ICH) during the postoperative acute phase is a rarely observed but severe complication. Its clinical features remain unclear due to its low incidence rate. The aim of this study was to clarify the clinical characteristics of immediate postoperative ICH. Methods: The authors retrospectively studied 201 consecutive combined revascularization procedures in 134 patients with MMD between January 2003 and November 2017. Demographics, perioperative clinical information, radiological findings and outcomes were documented in patients who demonstrated ICH immediately after surgery. The risk factors associated with postoperative ICH were analyzed. Results: Postoperative ICH was observed in 6 cases (2.99%, 95% confidence interval [CI] 1.38–6.36%; mean age = 46.0 ± 7.6 years). The onset timing of ICH in most patients was within 24 hours after surgery (83.3%). Hematomas were located at the subcortical lesion beneath the anastomosed cortex (n = 5) and caudate head (n = 1). Three cases (50.0%) required hematoma evacuation. A higher age at the surgery was associated with postoperative ICH (p = 0.046). In adult cases (132 surgeries, 65.7%), hemorrhagic presentation at the onset (odds ratio [OR] 16.0, 95% CI 2.46–312.8, p = 0.0027) and an increase in blood pressure (BP) from pre- to postoperative BP (systolic BP increase; OR 1.69, 95% CI 1.17–2.58, p = 0.0058, diastolic BP increase; OR 2.02, 95% CI 1.08–4.03, p = 0.0274; OR and 95% CI calculated by change of 10 mmHg) were significant risk factors of postoperative ICH. Conclusion: The results suggest that older patients, with hemorrhagic presentation and greater postoperative BP increase should be carefully managed to avoid postoperative ICH. Immediate hematoma evacuation may be effective in preventing devastating outcomes following postoperative ICH.