Arterial Ischemic Stroke in Moyamoya patients that underwent Vaginal Delivery and Cesarean.

Overview

INTRODUCTION: Moyamoya Disease (MMD) is characterized by stenosis, occlusion and formation of aberrant collaterals of brain vessels. This disordering in the brain vessels in conditions of the changes in intracranial pressure (ICP) can lead to arterial ischemic stroke (AIS). In pregnancy a major challenge for stroke physicians is to recommend the safest method of delivery for MMD patients. Hence, our objective was analyzed the risk of AIS in MMD patients that had vaginal delivery (VD) and cesarean section (c-section) using a large National database. MATERIAL AND METHODS: We used a National Inpatient Sample (NIS) database for the years from 2013 to 2018, identified admissions with diagnosis of MMD who underwent VD or c-section. Multiple logistic regression was performed to assess the risk of AIS in VD vs c-section. RESULTS: 2166 female MMD patients were captured, out of which 97 patients underwent VD or c-section, 49 (50.51%) of these patients had VD, and 48 (49.48%) had c-section. The analysis of outcomes between VD and c-section showed a higher prevalence of AIS in VD compared to c-section (8.2% vs 6.3%, p=0.716) The multivariate analysis for AIS showed that VD it is not an independent risk factor compared to c-section [OR=2.1, 95% CI:0.3-13.3, p=0.417]. CONCLUSION: Our data did not find evidence that VD or c-section are risk factors for AIS in MMD pregnant patients.