What is the expert's option on antiplatelet therapy in moyamoya disease? Results of a worldwide Survey
What is the expert's option on antiplatelet therapy in moyamoya disease? Results of a worldwide Survey
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DOI：
10.1111/j.1468-1331.2011.03481.x
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发表时间：
2012-01-01
影响因子：
5.1
通讯作者：
Khan, N.
中科院分区：
文献类型：
--
作者：
Kraemer, M.;Berlit, P.;Khan, N.
背景和目的：烟雾病（Moyamoya disease，MMD）是一种罕见的特发性血管病变，其特征是颈内动脉颅内段和Willis环近端前内侧动脉的双侧进行性狭窄和最终闭塞，形成广泛的细小侧支血管网。由于这种疾病的罕见性和伦理问题，完全缺乏关于治疗方案的双盲随机对照试验。适当的保守治疗，而不是血运重建手术之前或之后，几乎完全被忽视的科学文献，甚至在Asia.Methods：我们制定了一份问卷，提供了多项选择方法的响应选项。该调查是通过电子邮件发送的，要求在2010年9月至2011年1月期间回复治疗MMD的专家。作为一名国际专家，作者被选中，谁写了一个以上的科学文章或书籍章节的主题。我们特别注意，不仅选择亚洲科学家，但也考虑了专家的疾病在高加索patients.Results：在77名接受调查的医生，32（41.55%）回答。21名（65.6%）亚洲专家和11名（34.4%）非亚洲专家参与了本次调查。大多数专家认为长期抗血小板治疗对MMD的治疗并不重要。32名参与者中有10名（31%）同意接受乙酰水杨酸100 mg/天的长期抗血小板治疗。亚洲和非亚洲专家之间的答案有显着差异（P = 0.0128）。结论：有趣的是，大多数非亚洲受访者建议抗血小板药物，而这是一个不寻常的方法在MMD的亚洲专家。也许，这种显著差异是由与亚洲人和高加索人之间疾病表现差异相关的专家的不同经验所证实的。保守治疗和手术治疗在MMD中的作用需要更大的队列进一步评估，并关注长期临床结果。
Background and purpose: Moyamoya disease (MMD) is a rare idiopathic vasculopathy characterized by an extensive network of fine collaterals in the setting of bilateral progressive stenosis and finally occlusion of the intracranial portion of the internal carotid artery and proximal anterior and medial arteries of Circle of Willis. Owing to the rarity of the disease and ethical concerns, double-blinded, randomized controlled trials about treatment options are completely lacking. The appropriate conservative treatment instead, before or after revascularization surgery, is nearly completely neglected in scientific literature, even in Asia.Methods: We developed a questionnaire with response options offered in the multiple choice method. The survey was sent with the request to reply within September 2010 to January 2011 by email to experts in the treatment of MMD. As an international expert, authors were selected who had written more than one scientific article or book chapter on the subject. We took special care not to select only Asian scientists, but also considered experts on the disease in Caucasian patients.Results: Among the 77 physicians surveyed, 32 (41.55%) responded. Twenty-one (65.6%) Asian experts and 11 (34.4%) non-Asian experts participated in this survey. The majority of experts thought that long-term antiplatelet therapy is not essential in the treatment of MMD. Ten of 32 (31%) participants agreed to long-term antiplatelet treatment with acetylsalicylic acid 100 mg/day. There was a significant difference in answers between Asian and non-Asian experts (P = 0.0128).Conclusion: It is interesting that the majority of Non-Asian respondents recommend antiplatelet drugs, while this is an unusual approach in MMD of the Asian experts. Perhaps, this significant difference is well founded by the different experiences of the experts related to the difference in disease presentation between Asians and Caucasians. The role of conservative and surgical treatment in MMD needs further evaluation with larger cohorts and a focus on long-term clinical outcome.