Hemorrhage and risk of further hemorrhagic strokes following cerebral revascularization in Moyamoya disease: A review of the literature.
Hemorrhage and risk of further hemorrhagic strokes following cerebral revascularization in Moyamoya disease: A review of the literature.
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DOI：
10.4103/2152-7806.97730
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发表时间：
2012
影响因子：
--
通讯作者：
Britz GW
中科院分区：
文献类型：
--
作者：
Ryan RW;Chowdhary A;Britz GW
我们试图回顾有关烟雾病（MMD）脑血管重建术后未来出血风险的现有文献。我们使用 PubMed 进行了全面的文献综述，以检查有关 MMD 血运重建后出血风险的可用数据。在这篇综述中，我们确定了脑血管重建术前后与 MMD 出血相关的危险因素。我们提出了出血风险的病理生理学、搭桥类型的作用、治疗方案以及未来的研究需求。已发表的 MMD 治疗案例和系列确实表明，无论是在近期还是长期，直接或间接搭桥治疗后都存在出血风险。虽然这些出血的发生率没有明显的模式，但有 III 类证据表明多次微出血对术前影像学具有预测作用。此外，虽然直接和间接血运重建已被证明可以减少MMD引起的缺血性并发症，但与手术后出血的风险无关。需要进行进一步的研究，以帮助评估危险因素是什么，以及如何就这种疾病过程的长期前景向患者提供咨询。
We sought to review the current literature with regards to future risks of hemorrhage following cerebral revascularization in Moyamoya disease (MMD). We performed a comprehensive literature review using PubMed to inspect the available data on the risk of hemorrhage after revascularization in MMD. In this review, we identify the risk factors associated with hemorrhage in MMD both before and after cerebral revascularization. We included proposed pathophysiology of the hemorrhagic risk, role of the type of bypass performed, treatment options, and future needs for investigation. The published cases and series of MMD treatment do show a risk of hemorrhage after treatment with either direct or indirect bypass both in the immediate as well as long-term future. While there are no discernible patterns in the rate of these hemorrhages, there is Class III evidence for the predictive effect of multiple microbleeds on preoperative imaging. Also, whereas revascularization, both direct and indirect, has been shown to reduce ischemic complications from MMD, there is not an association with the risk of hemorrhage after the procedure. Further studies need to be performed to help evaluate what the risk factors are and how to counsel patients as to the long-term outlook of this disease process.