Radiological findings, clinical course, and outcome in asymptomatic Moyamoya disease - Results of multicenter survey in Japan
Radiological findings, clinical course, and outcome in asymptomatic Moyamoya disease - Results of multicenter survey in Japan
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DOI：
10.1161/strokeaha.106.478297
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发表时间：
2007-05-01
期刊：
影响因子：
8.3
通讯作者：
Iwasaki, Yoshinobu
中科院分区：
文献类型：
--
作者：
Kuroda, Satoshi;Hashimoto, Nobuo;Iwasaki, Yoshinobu
背景和目的——尽管无创磁共振检查的发展增加了识别无卒中发作的无症状烟雾病患者的机会，但其临床特征仍不清楚。这是日本首个针对无症状烟雾病的多中心全国性调查，旨在阐明其临床特征。方法：收集2003 - 2006年日本12家医院无症状烟雾病患者的临床数据库。这项历史前瞻性队列研究共纳入了40例患者。其中6例行手术血运重建术，包括颞浅动脉与大脑中动脉吻合和/或颅底吻合。评估了他们的人口统计学和放射学结果以及结果。结果-在初步评估中，分别在大约20%和40%的受累半球中检测到脑梗死和脑血流动力学紊乱。老年患者血管造影分期更早。在34例非手术治疗的患者中，7例在随访期间（平均43.7个月）发生过短暂性脑缺血发作（n = 3）、缺血性脑卒中（n = 1）或颅内出血（n = 3）。任何中风的年风险为3.2%。5例患者中有4例疾病进展与缺血性事件或无症状梗死相关。6例行手术血运重建术的患者均未发生脑血管事件。结论-研究结果显示无症状烟雾病不是一种沉默的疾病，可能导致缺血性或出血性中风。对无症状的烟雾病患者应仔细随访，进一步明确其预后，并为其制定治疗指南。
Background and Purpose - Although the development of a noninvasive MR examination has increased the opportunity to identify asymptomatic patients with moyamoya disease who have experienced no stroke episodes, their clinical features are still unclear. This was the first multicenter, nation-wide survey focused on asymptomatic moyamoya disease in Japan and was designed to clarify their clinical features.Methods - A clinical database of asymptomatic patients with moyamoya disease was collected from 12 participating hospitals in Japan between 2003 and 2006. In total, 40 patients were enrolled in this historical prospective cohort study. Of these, 6 underwent surgical revascularization, including superficial temporal artery to middle cerebral artery anastomosis and/or pial synangiosis. Their demographic and radiological findings as well as outcome were evaluated.Results - On initial evaluation, cerebral infarction and disturbed cerebral hemodynamics were detected in approximate to 20% and 40% of the involved hemispheres, respectively. Angiographical stage was more advanced in more elderly patients. Of 34 nonsurgically treated patients, 7 experienced transient ischemic attack ( n = 3), ischemic stroke ( n = 1), or intracranial bleeding ( n = 3) during follow-up periods ( mean, 43.7 months). The annual risk for any stroke was 3.2%. Disease progression was associated with ischemic events or silent infarction in 4 of 5 patients. No cerebrovascular event occurred in the 6 patients who underwent surgical revascularization.Conclusions - The findings revealed that asymptomatic moyamoya disease is not a silent disorder and may potentially cause ischemic or hemorrhagic stroke. Asymptomatic patients with moyamoya disease should be carefully followed-up to further clarify their outcome and to establish the management guideline for them.