Background/aims: Limited data exist on the perioperative management of patients with moyamoya angiopathy (MMA) undergoing non-revascularisation surgery. These patients are at increased risk of cerebrovascular events due to hypotension-induced hypoperfusion and hypocapnia-driven vasoconstriction. This study aimed to evaluate perioperative management strategies and cerebrovascular complications in a cohort of MMA patients.
Methods: We conducted a retrospective analysis of patients with known MMA undergoing non-revascularisation surgery. Collected data included demographics, MMA phenotype, surgery type, intraoperative systolic blood pressure (SBP) and end-tidal CO2 (ETCO₂), and perioperative cerebrovascular events. Descriptive statistics were used to summarise findings, and associations assessed using nonparametric tests.
Results: We identified 25 patients (84% female), median age 48 years (IQR 32–59). A prior cerebrovascular event had occurred in 88% of patients at a median of 1,080 days (IQR 143–3,537) before surgery. In 80% of cases, MMA involved both supraclinoid internal carotid arteries. Surgical procedures included gynecological (20%), musculoskeletal (28%), general surgery (12%), neurosurgical (e.g., intraventricular shunt, subdural evacuation; 20%), and miscellaneous procedures (20%). Median outpatient systolic blood pressure (SBP) was 125 mmHg (IQR 120–150), compared to a median intraoperative SBP of 130 mmHg (IQR 115–150), with no significant difference on paired analysis (p=0.8). Median intraoperative end-tidal CO₂ was 4.8 kPa (IQR 4.0–5.3). No perioperative cerebrovascular events were recorded.
Conclusion: In this cohort, maintaining intraoperative SBP within outpatient levels appeared effective in preventing perioperative cerebrovascular events. Our findings indicate that this approach could be safe for MMA patients undergoing non-revascularisation surgery; however, larger studies are needed to confirm this.