2026 Proffered Presentations
S004: PREDICTING POSTOPERATIVE STROKE AFTER STA-MCA BYPASS IN MOYAMOYA DISEASE USING CT PERFUSION: A MULTIVARIATE META-REGRESSION STUDY
David Cho, BS1; Gerardo Duran, BS1; Cory Greer, BS1; Abdurrahman F Kharbat, MD2; Michael J Feldman, MD2; Andrew M Bauer, MD2; Christopher S Graffeo, MD, MS2; 1OU College of Medicine; 2OU Health
Background: Moyamoya disease (MMD) is a cerebrovascular disease characterized by idiopathic progressive stenosis, fragile compensatory vessel formation, and subsequent ischemic or hemorrhagic events. Revascularization via direct STA-MCA bypass is the standard intervention in western adult MMD patients, though carrying the risk of postoperative stroke as a procedural complication. Recent studies have demonstrated the utility of CTP in predicting postoperative stroke following STA-MCA bypass for MMD. As such, we present a novel meta-analysis of preoperative, postoperative, and differential CTP parameters as predictors of postoperative stroke in adult patients undergoing STA-MCA bypass for MMD.
Methods: A PRISMA-compliant systematic review was conducted across MEDLINE and Embase databases from inception to December 2024. We included primary studies of STA-MCA bypass for adult MMD that reported the CTP parameters relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time (rMTT), and relative time-to-peak (rTTP), alongside postoperative stroke incidence. Among 138 candidate citations, 34 underwent full-text review, and 9 studies representing 746 patients met study criteria and were included. Multivariate meta-regression analyses were conducted, as well as sensitivity analyses excluding those studies with calculated relative values, hemorrhagic MMD only, or mixed results from both direct and indirect bypass operations.
Results: Preoperative CTP parameters including elevated rTTP (β=0.143, p=0.013) and rCBF (β=0.165, p=0.007) were significantly associated with postoperative stroke, while rCBV demonstrated a protective effect (β=-0.133, p=0.001). Postoperative parameters were not significantly associated with postoperative stroke in the overall analysis. Sensitivity analyses revealed significance for rCBF, rCBV, and rTTP except when studies reporting mixed direct and indirect bypass cases were excluded. Differential parameters, ΔrTTP (β=-0.2793, p=0.0186) and ΔrCBF (β=-0.1175, p=0.0001), were negatively associated with postoperative stroke. Heterogeneity was minimal (I²=0%, τ²=0, p>0.05 Q-tests), and no publication bias was detected on Egger’s regression tests and funnel plots.
Conclusion: Preoperative rTTP, rCBF, and rCBV are robust predictors of postoperative stroke in MMD patients undergoing STA-MCA bypass. Large deviations from an expected response to bypass, excessive reduction in ΔrTTP and lack of therapeutic ΔrCBF improvement, were also predictive of postoperative stroke, highlighting the potential benefit of close monitoring for this high-risk population following STA-MCA bypass. These findings highlight the utility of CTP for surgical risk stratification. Future research should integrate clinical and multimodal data to refine predictive models and establish standardized CTP thresholds for better, stroke-free futures for our patients.