Baseline Hemodynamic Impairment and Future Stroke Risk in Adult Idiopathic Moyamoya Phenomenon: Results of a Prospective Natural History Study.
Baseline Hemodynamic Impairment and Future Stroke Risk in Adult Idiopathic Moyamoya Phenomenon: Results of a Prospective Natural History Study.
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DOI：
10.1161/strokeaha.116.014538
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发表时间：
2017-04
期刊：
影响因子：
8.3
通讯作者：
Dacey RG Jr
中科院分区：
文献类型：
--
作者：
Derdeyn CP;Zipfel GJ;Zazulia AR;Davis PH;Prabhakaran S;Ivan CS;Aiyagari V;Sagar JR;Hantler N;Shinawi L;Lee JJ;Jafri H;Grubb RL Jr;Miller JP;Dacey RG Jr
The purpose was to test the hypothesis that increased oxygen extraction fraction (OEF), a marker of severe hemodynamic impairment measured by positron emission tomography, is an independent risk factor for subsequent ischemic stroke in this population. Adults with idiopathic moyamoya phenomena were recruited between 2005 and 2012 for a prospective, multi-center, blindly-adjudicated, longitudinal cohort study. Measurements of OEF were obtained on enrollment. Subjects were followed for the occurrence of ipsilateral ischemic stroke at six month intervals. Patients were censored at the time of surgical revascularization or at last follow-up. The primary analysis was time to ischemic stroke in the territory of the occlusive vasculopathy. Forty nine subjects were followed over a median 3.7 years. One of 16 patients with increased OEF on enrollment suffered an ischemic stroke and another had an intraparenchymal hemorrhage. Three of 33 patients with normal OEF suffered an ischemic stroke. On a per hemisphere basis, 21 of 79 hemispheres with moyamoya vasculopathy had increased OEF at baseline. No ischemic strokes and one hemorrhage occurred in a hemisphere with increased OEF (n=21). Sixteen patients (20 hemispheres), including 5 with increased OEF at enrollment, were censored at a mean of 5.3 months after enrollment for revascularization surgery. The risk of new or recurrent stroke was lower than expected. The low event rate, low prevalence of increased OEF and potential selection bias introduced by revascularization surgery limit strong conclusions regarding the association of increased OEF and future stroke risk. https://clinicaltrials.gov. Unique Identifier NCT00629915
