Development and validation of a scoring system to evaluate and clinically manage postoperative acute infarction complications in moyamoya disease.

Background: Revascularization is the most widely used treatment for moyamoya disease (MMD) but is associated with relatively high incidence of ischaemic complications in adult patients. At present, the guidelines in various countries do not include effective recommendations regarding postoperative complications, and a simple, practical and reliable scoring system is needed for rapid clinical evaluation and decision-making.

Methods: In this prognostic study, we developed a prediction model based on a single-centre cohort and validated it in a multicentre external prospective cohort. All patients were followed for at least 30 days to confirm whether postoperative acute cerebral infarction occurred.

Results: Among 2992 patients, 1980 patients are included in the derivation cohort, and 1012 patients compose the external validation cohort. Postoperative acute cerebral infarction occurs in 131 patients (6.62%) in the derivation cohort and 91 patients (8.99%) in the external validation cohort. Six risk factors are ultimately included in the development of the scoring system (CAMPIS). In the internal validation cohort, the Matthews correlation coefficient (MCC) and the concordance index (C-index) are 0.690 (0.681-0.698) and 0.956 (0.955-0.956), respectively. In the external validation cohort, the MCC and C-index are 0.762 (0.761-0.764) and 0.972 (0.971-0.973), respectively. In the derivation and validation cohorts, the postoperative infarction rates are 0.96% and 0.53%, 25.95% and 48.68%, and 84.71% and 89.47%, respectively, in the low-risk group, the medium-risk group, and the high-risk group.

Conclusions: CAMPIS is a reliable and practical tool that can be used to facilitate decision-making and avoid potentially harmful interventions, serving as an effective complement to the existing guidelines in the assessment and control of postoperative ischaemic complications.