Effects and safety of aspirin use in patients after cerebrovascular bypass procedures.
Effects and safety of aspirin use in patients after cerebrovascular bypass procedures.
复制标题
脑血管搭桥手术后患者使用阿司匹林的效果和安全性。
DOI：
10.1136/svn-2020-000770
复制
发表时间：
2021-12
影响因子：
5.9
通讯作者：
Zhao JZ
中科院分区：
文献类型：
--
作者：
Lu J;Shi G;Zhao Y;Wang R;Zhang D;Chen X;Wang H;Zhao JZ
颞浅动脉至大脑中动脉（STA-MCA）搭桥是治疗烟雾病（MMD）最有效的方法。在这项研究中，我们旨在评估阿司匹林是否能改善STA-MCA搭桥通畅，以及对烟雾病患者是否安全。我们对2011年1月至2018年8月期间在两家医院接受STA-MCA搭桥治疗的缺血性烟雾病患者进行了回顾性医疗记录回顾，以阐明STA-MCA搭桥后阿司匹林的疗效和安全性。比较FU旁路通畅与闭塞患者末次随访时的神经功能状况。结果217例患者（238个半球）中，平均年龄为41.4±10.2岁，男性占51.8%；STA-MCA搭桥的适应症是卒中（48.2%），其次是短暂性缺血发作（44.0%）。所有病例均证实立即旁路通畅。在FU期间（1.5±1.5 y）， 15例患者在FU显像处闭塞，总体累计通畅率为94%。短期FU组（n=131，平均FU时间0.5±0.2年）和长期FU组（n=107，平均FU时间4.1±3.5年）的通畅率分别为93%和94%。阿司匹林组STA-MCA搭桥通畅率高于非阿司匹林组（98.7% vs 89.7%; HR 1.57; 95% CI 1.106 ~ 2.235; p=0.012）。阿司匹林组和非阿司匹林组FU出血事件无显著差异。在接受STA-MCA搭桥手术的缺血性烟雾病成年患者中，阿司匹林可能会增加搭桥通畅率，但不会增加出血风险。FU旁路通畅可能与更好的预后相关。需要进一步的研究，特别是精心设计的前瞻性研究来确定阿司匹林在心脏搭桥手术后的作用。
Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is the most effective treatment for Moyamoya disease (MMD). In this study, we aimed to assess whether aspirin improves STA-MCA bypass patency and is safe in patients with MMD. We performed a retrospective medical record review of patients with ischaemic-onset MMD who had undergone STA-MCA bypass at two hospitals between January 2011 and August 2018, to clarify the effects and safety of aspirin following STA-MCA bypass. The neurological status at the last follow-up (FU) was compared between patients with FU bypass patency and occlusion. Results Among 217 identified patients (238 hemispheres), the mean age was 41.4±10.2 years, and 51.8% were male; the indications for STA-MCA bypass were stroke (48.2%), followed by a transient ischaemic attack (44.0%). Immediate bypass patency was confirmed in all cases. During the FU period (1.5±1.5 y), 15 cases were occluded at FU imaging, resulting in an overall cumulative patency rate of 94%. The patency rates were 93% and 94% in the short-term FU group (n=131, mean FU time 0.5±0.2 years) and long-term FU group (n=107, mean FU time 4.1±3.5 years), respectively. The STA-MCA bypass patency rate in the aspirin group was higher than that in the non-aspirin group (98.7% vs 89.7%; HR 1.57; 95% CI 1.106 to 2.235; p=0.012). No significant difference in the FU haemorrhagic events was observed between the aspirin and non-aspirin groups. Among adult patients with ischaemic-onset MMD undergoing STA-MCA bypass procedures, aspirin might increase the bypass patency rate, without increasing the bleeding risk. FU bypass patency may be associated with a better outcome. Additional studies, especially carefully designed prospective studies, are needed to address the role of aspirin after bypass procedures.
登录
查看更多内容
影响因子：
4.1
作者：
Zhao, Meng;Deng, Xiaofeng;Zhao, Jizong
通讯作者：
Zhao, Jizong
影响因子：
3.3
作者：
Ibanez, Borja;James, Stefan;Widimsky, Petr
通讯作者：
Widimsky, Petr
影响因子：
--
作者：
SUZUKI, J;TAKAKU, A
通讯作者：
TAKAKU, A
影响因子：
158.5
作者：
BARNETT, HJM
通讯作者：
BARNETT, HJM
影响因子：
5.1
作者：
Kraemer, M.;Berlit, P.;Khan, N.
通讯作者：
Khan, N.