For
moyamoya disease (MMD) patients who suffered an acute ischemic attack, the
infarction patterns on DWI and its association with recurrent adverse cerebrovascular events (
ACEs) after bypass surgery remain unknown. 327 patients who suffered an acute ischemic attack and received following revascularization surgery were retrospectively reviewed and were divided into three patterns according to the lesion number and distribution on DWI that obtained within 7 days of onset: no acute
infarction (NAI), single acute
infarction (SAI), and multiple acute
infarctions (MAIs). We used Cox proportional hazard models to estimate hazard ratios (HR) for associations of
infarction patterns and the risk of recurrent
ACEs and
strokes. Over a median follow-up of 41 months (IQR 26-60), there were 61
ACEs and 27
strokes. Compared to the NAI cohort, patients with SAI (HR, 2.92; 95% CI, 1.41-6.05; p = 0.004) and MAIs (HR, 4.44; 95% CI, 2.10-9.41; p < 0.001) were associated with higher risk of
ACEs recurrences. In analysis adjusted for age and surgery modalities, the corresponding HR was 2.90 (95% CI: 1.41-5.98) for SAI and 4.10 (95% CI: 1.95-8.63) for MAIs, and this effect remained persistent on further adjustment for several potential confounders. Similar but less precise association was found in separate analysis that only takes into account
stroke recurrences. Thus, different
infarction patterns on DWI imply different risks of recurrent
ACEs, and more attention should be paid to prevent
ACEs in MMD patients with MAIs.