Ivy Sign Predicts Ischemic Stroke Recurrence in Adult Moyamoya Patients without Revascularization Surgery
Ivy Sign Predicts Ischemic Stroke Recurrence in Adult Moyamoya Patients without Revascularization Surgery
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DOI：
10.1159/000500610
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发表时间：
2019-09-01
影响因子：
2.9
通讯作者：
Son, Young-Je
中科院分区：
文献类型：
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作者：
Nam, Ki-Woong;Cho, Won-Sang;Son, Young-Je
背景资料：尽管烟雾病（MMD）患者的血运重建手术有一个标准指南，但仍需要更客观和更容易获得的预测指标。目的：在这项研究中，我们的目的是评估同侧常春藤征和缺血性卒中复发之间的关系，在成年MMD患者没有血运重建手术。方法：我们纳入了2006年至2014年期间未接受血运重建手术的连续MMD患者。常春藤征定义为液体衰减反转恢复图像上的线性或局灶性高信号强度，并对每个半球的常春藤征负荷进行评级。缺血性卒中复发被定义为伴随磁共振成像上新的脑病变的新的临床事件。结果：总体而言，分析了84例患者的154个半球。我们发现9例（6%）半球在3年内复发缺血性卒中。在多变量分析中，同侧常春藤征仍然是3年缺血性复发的独立预测因子（校正风险比[aHR] 10.15，95% CI 2.10-49.14，p = 0.004）。初始表现为梗死也具有显著性（aHR 7.15，95% CI 1.36-36.78，p = 0.019）。Ivy征负荷与3年缺血复发率呈剂量-反应关系（P < 0.001）。当比较有和无Ivy征和灌注缺陷的4组之间的缺血复发率时，“Ivy征（+）灌注缺陷（+）组”在观察到的（p = 0.005）和估计的（p = 0.003）3年缺血复发方面均显示出比另一组显著更高的风险。此外，“Ivy征（+）灌注缺陷（-）组”的复发率高于“Ivy征（-）灌注缺陷（+）组”。结论：常春藤征与成人MMD患者缺血复发呈剂量-反应关系。这将有助于选择需要血运重建手术的高危患者。
Background: Although there is a standard guideline for performing revascularization surgery in patients with Moyamoya diseases (MMD), more objective and easily obtainable predictors are still needed. Objectives: In this study, we aimed to evaluate the relationship between an ipsilateral ivy sign and ischemic stroke recurrence in adult MMD patients without revascularization surgery. Methods: We included consecutive MMD patients without revascularization surgery between 2006 and 2014. The ivy sign was defined as a linear or focal high-signal intensity on fluid-attenuated inversion recovery images, and the burdens of ivy sign were rated in each hemisphere. The ischemic stroke recurrence was defined as a new clinical event that accompanied a new brain lesion on magnetic resonance imaging. Results: Overall, 84 patients with 154 hemispheres were analyzed. We found recurrent ischemic stroke in 9 (6%) hemispheres within 3 years. In multivariate analysis, an ipsilateral ivy sign remained an independent predictor of 3-year ischemic recurrence (adjusted hazard ratio [aHR] 10.15, 95% CI 2.10-49.14, p = 0.004). An initial presentation as infarction was also significant (aHR 7.15, 95% CI 1.36-36.78, p = 0.019). The burdens of ivy sign showed a dose-response tendency with the 3-year ischemic recurrence rate (p < 0.001). When comparing the ischemic recurrence rate among 4 groups with and without ivy sign and perfusion defect, the "Ivy sign (+) Perfusion defect (+) group" showed a significantly higher risk in both observed (p = 0.005) and estimated (p = 0.003) 3-year ischemic recurrence than did the other group. Additionally, the "Ivy sign (+) Perfusion defect (-) group" showed a higher recurrence rate than did the "Ivy sign (-) Perfusion defect (+) group". Conclusions: The ivy sign is associated with ischemic recurrence in adult MMD patients in a dose-response manner. It would be helpful for selecting high-risk patients who need revascularization surgery.