Revascularization Surgery in Childhood Associated with a Low Incidence of Microbleeds in Adult Patients with Moyamoya
Revascularization Surgery in Childhood Associated with a Low Incidence of Microbleeds in Adult Patients with Moyamoya
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儿童时期的血运重建手术与成人烟雾病患者的微出血发生率较低相关
DOI：
10.1016/j.wneu.2019.09.144
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发表时间：
2020
影响因子：
2
通讯作者：
Miyamoto Susumu
中科院分区：
文献类型：
--
作者：
Yamao Yukihiro;Takahashi Jun C.;Funaki Takeshi;Mineharu Yohei;Kikuchi Takyuki;Okada Tomohisa;Togashi Kaori;Miyamoto Susumu
背景烟雾病中无症状微出血的临床意义尚不清楚。本研究旨在阐明搭桥手术与无症状小出血发生率的关系。方法对142例成年烟雾病患者进行回顾性研究，其中36例(25.3%)在儿童时期曾接受搭桥手术。出血性发作31例(21.8%)。从3-T磁共振成像的T2*加权或磁化率加权成像评估微出血的发生率。这些患者随后被分成MBS(微出血)组和非MBS组。由于先前的微量出血可能导致出血，MBS组被定义为有出血的放射证据的患者，包括无症状的微量出血和/或出血发作。结果38例患者(26.8%)出现无症状微出血。在31例出现出血的患者中，18例有微量出血，而13例没有微量出血。因此，51例患者(35.9%)被归入MBS组。儿童时期的搭桥手术(MBS，7.8%vs非MBS，35.2%；P<；0.01)和年龄(MBS，42.9±1.8岁vs非MBS，34.7±1.4岁；P<；0.01)是与微出血相关的统计学显著因素，但只有儿童期的搭桥手术在多变量调整后仍具有统计学意义(优势比，0.25；95%可信区间，0.07-0.87；结论儿童时期血管重建术的临床意义与成年烟雾病患者无症状微出血发生率低有关。这一发现表明，新建立的分流术可以减少血流动力学过载。
BackgroundThe clinical significance of asymptomatic microbleeds in moyamoya disease remains unclear. The purpose of this study was to clarify the relationship between bypass surgery and the incidence of asymptomatic microbleeds.MethodsThis retrospective study included 142 adult patients (mean age, 37.7 ± 13.5 years) with moyamoya disease, 36 of whom (25.3%) underwent bypass surgery in childhood. Hemorrhagic onset was diagnosed in 31 patients (21.8%). The incidence of microbleeds was evaluated on T2*-weighted or susceptibility-weighted imaging from 3-T magnetic resonance imaging. The patients were subsequently categorized into MBs (microbleeds) or non-MBs groups. Because previous microbleeds potentially lead to hemorrhage, the MBs group was defined as patients with radiographic evidence of bleeding, including asymptomatic microbleeds and/or hemorrhagic onset. The association of baseline characteristics was evaluated.ResultsAsymptomatic microbleeds were detected in 38 patients (26.8%). Of 31 patients with hemorrhagic onset, 18 had microbleeds, whereas 13 had no microbleeds. Therefore, 51 patients (35.9%) were classified into the MBs group. Bypass surgery in childhood (MBs, 7.8% vs. non-MBs, 35.2%;P< 0.01) and age (MBs, 42.9 ± 1.8 years vs. non-MBs, 34.7 ± 1.4 years;P< 0.01) were statistically significant factors associated with microbleeds, but only bypass surgery in childhood remained statistically significant after multivariable adjustment (odds ratio, 0.25; 95% confidence interval, 0.07–0.87;P= 0.03).ConclusionsThis study shows the clinical significance of revascularization surgery in childhood associated with a low incidence of asymptomatic microbleeds in adult patients with moyamoya disease. This finding indicates that a newly established bypass can reduce hemodynamic overstress.