Predictors of dura-brain neoangiogenesis after combined revascularization for patients with symptomatic atherosclerotic cerebral artery occlusion: A multivariate regression analysis

Background The predictors of the efficacy of indirect revascularization in nonmoyamoya patients have not been determined. Our study was designed to investigate the independent predictors of dura-brain neoangiogenesis (DBN) after superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass combined with dural inversion (DI) in patients with symptomatic atherosclerotic cerebral arterial occlusion (SACAO). Methods We retrospectively analyzed SACAO patients who had undergone STA-MCA bypass combined with DI at our center between November 2014 and October 2021. DBN was evaluated by super-selective digital subtraction angiography and scored by the DBN scoring system. Independent predictors of DBN were identified by multivariate logistic regression analysis. The differences in clinical outcomes between patients with “good” and “poor” DBN were also analyzed. Results A total of 179 SACAO patients with an average age of 61.3 ± 7.0 years and an average follow-up of 63.0 ± 22.0 months were studied. Ninety-nine patients (55.3%) had good DBN, and 80 patients (44.7%) had poor DBN. Multivariate analysis revealed that old age (p < 0.001, OR [95% CI] 1.288 [1.184–1.400]) was an independent predictor of poor DBN, with an optimal cutoff of 64.5 years. Diabetes (p = 0.005, OR [95% CI] 3.358 [1.434–7.867]) also independently predicted poor DBN. The recurrence rate of ischemic events in the good DBN group was significantly lower than that in the poor DBN group (2.0% vs. 10.0%, p = 0.044). The neurological status of patients in the good DBN group was significantly better than that of patients in the poor DBN group. Conclusion Old age and diabetes status were found to be independent predictors of poor DBN after combined revascularization in SACAO patients. Good DBN was associated with a lower recurrence rate of stroke and better neurological status. Future studies are needed to clarify the underlying pathophysiological mechanisms involved.