Efficacy and Safety of Antiplatelet Agents for Adult Patients With Ischemic Moyamoya Disease.
Efficacy and Safety of Antiplatelet Agents for Adult Patients With Ischemic Moyamoya Disease.
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DOI：
10.3389/fneur.2020.608000
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发表时间：
2020
影响因子：
3.4
通讯作者：
Sheng W
中科院分区：
文献类型：
--
作者：
Ye F;Li J;Wang T;Lan K;Li H;Yin H;Guo T;Zhang X;Yang T;Liang J;Wu X;Li Q;Sheng W
背景：抗血小板药物在缺血性烟雾病（MMD）中的应用存在争议。本研究旨在探讨抗血小板治疗与保守治疗和手术血运重建相比在缺血性MMD患者中的有效性和安全性。方法：从2013年1月至2018年12月，从8个临床研究中心回顾性入组缺血性MMD患者。从首次出院至2019年12月，通过临床访视和/或电话访谈进行随访。主要结局是进一步缺血发作的发作，次要结局是个体功能状态。未来卒中的危险因素通过LASSO-Cox回归模型确定。使用TriMatch软件包，将倾向评分匹配用于组装具有相似基线特征的患者队列。结果：在217名符合条件的患者中，经过1：1：1倾向评分匹配后，159名患者被纳入分析。在平均随访33个月时，12名患者（7.5%）进一步发生脑缺血事件（手术：抗血小板：保守= 1：3：8; p = 0.030），26例患者（16.4%）功能状态差（手术：抗血小板：保守= 7：12：7; p = 0.317），3例患者（1.8%）死于脑出血（手术：抗血小板：保守= 1：2：0; p = 0.361）。生存曲线显示，手术血运重建组进一步脑缺血发作的风险最低，而抗血小板治疗与保守治疗相比，在预防复发风险方面具有统计学意义（χ2 = 8.987; p = 0.011）。功能状态和出血事件无显着差异。LASSO-Cox回归模型显示MMD家族史（HR = 6.93; 95% CI：1.28-37.52; p = 0.025），既往有卒中或短暂性脑缺血发作史（HR = 4.35; 95% CI：1.09-17.33; p = 0.037）和治疗（HR = 0.05; 95% CI：0.01-0.32; p = 0.001）与复发性卒中风险显著相关。结论：抗血小板药物对预防成人缺血性MMD患者再发脑缺血发作是安全有效的。它们可能是有手术禁忌症的患者和血运重建前患者的替代疗法。
Background: The use of antiplatelet agents in ischemic moyamoya disease (MMD) is controversial. This study aimed to investigate the effectiveness and safety of antiplatelet therapy compared with conservative treatment and surgical revascularization in ischemic MMD patients. Methods: Ischemic MMD patients were retrospectively enrolled from eight clinical sites from January 2013 to December 2018. Follow-up was performed through clinical visits and/or telephone interviews from first discharge to December 2019. The primary outcome was the episodes of further ischemic attacks, and the secondary outcome was the individual functional status. Risk factors for future stroke were identified by the LASSO-Cox regression model. Propensity score matching was applied to assemble a cohort of patients with similar baseline characteristics using the TriMatch package. Results: Among 217 eligible patients, 159 patients were included in the analyses after a 1:1:1 propensity score matching. At a mean follow-up of 33 months, 12 patients (7.5%) developed further incident cerebral ischemic events (surgical:antiplatelet:conservative = 1:3:8; p = 0.030), 26 patients (16.4%) developed a poor functional status (surgical:antiplatelet:conservative = 7:12:7; p = 0.317), and 3 patients (1.8%) died of cerebral hemorrhage (surgical:antiplatelet:conservative = 1:2:0; p = 0.361). The survival curve showed that the risk of further cerebral ischemic attacks was lowest with surgical revascularization, while antiplatelet therapy was statistically significant for preventing recurrent risks compared with conservative treatment (χ2 = 8.987; p = 0.011). No significant difference was found in the functional status and bleeding events. The LASSO-Cox regression model revealed that a family history of MMD (HR = 6.93; 95% CI: 1.28–37.52; p = 0.025), a past history of stroke or transient ischemic attack (HR = 4.35; 95% CI: 1.09–17.33; p = 0.037), and treatment (HR = 0.05; 95% CI: 0.01–0.32; p = 0.001) were significantly related to the risk of recurrent strokes. Conclusions: Antiplatelet agents were effective and safe in preventing further cerebral ischemic attacks in adult patients with ischemic MMD. They may be a replacement therapy for patients with surgical contraindications and for patients prior to revascularization.
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影响因子：
8.3
作者：
Duan, Lian;Bao, Xiang-Yang;Feng, Jie
通讯作者：
Feng, Jie
影响因子：
4.1
作者：
Lee, Jaehoon;Little, Todd D.
通讯作者：
Little, Todd D.
影响因子：
9.9
作者：
Wang, Yue;Zhang, Zhengshan;Duan, Lian
通讯作者：
Duan, Lian
影响因子：
2.6
作者：
Antonelli, Alessandro;Minervini, Andrea;Serni, Sergio
通讯作者：
Serni, Sergio
影响因子：
6
作者：
Kraemer, Markus;Schwitalla, Jan Claudius;Berlit, Peter
通讯作者：
Berlit, Peter