Direct versus indirect bypasses for adult ischemic-type moyamoya disease: a propensity score-matched analysis
Direct versus indirect bypasses for adult ischemic-type moyamoya disease: a propensity score-matched analysis
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DOI：
10.3171/2017.2.jns162405
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发表时间：
2018-06-01
影响因子：
4.1
通讯作者：
Zhao, Jizong
中科院分区：
文献类型：
--
作者：
Deng, Xiaofeng;Gao, Faliang;Zhao, Jizong
目的烟雾病(MMD)的最佳手术方式尚不清楚。本研究的目的是比较直接搭桥术(DB)和间接搭桥术(IB)治疗成人缺血型MMD的手术效果。失访或随访期少于12个月的患者被排除在外。1：1倾向性评分匹配后，比较两组患者最后一次随访时的卒中复发事件和改良Rankin量表(MRS)评分。结果共纳入220例患者，其中接受DB的143例，接受IB的77例。经过倾向性得分匹配后，得到70对。中位随访期DB组为40.5月(14-75个月)，IB组为31.5个月(14-71个月)(p=0.004)。卡普兰-迈耶分析显示，与接受IB的患者(平均61.0个月)相比，接受DB的患者有更长的无中风时间(平均72.1月)(p=0.045)。良好的神经状态(MRS评分
OBJECTIVE The optimal surgical modality for moyamoya disease (MMD) remains unclear. The aim of this study was to compare the surgical effects of direct bypass (DB) and indirect bypass (IB) in the treatment of adult ischemic-type MMD.METHODS Adult patients with ischemic-type MMD who underwent either DB or IB from 2009 to 2015 were identified retrospectively from a prospective database. Patients lost to follow-up or with a follow-up period less than 12 months were excluded. Recurrent stroke events and modified Rankin Scale (mRS) scores at the last follow-up were compared between the 2 surgical groups after 1:1 propensity score matching.RESULTS A total of 220 patients were considered, including 143 patients who underwent DB and 77 patients who underwent IB. After propensity score matching, 70 pairs were obtained. The median follow-up period was 40.5 months (range 14-75 months) in the DB group and 31.5 months (range 14-71 months) in the IB group (p = 0.004). Kaplan-Meier analysis showed that patients who received DB had a longer stroke-free time (mean 72.1 months) compared with patients who received IB (mean 61.0 months) (p = 0.045). Good neurological status (mRS score