Functional Outcomes After Revascularization Procedures in Patients With Hemorrhagic Moyamoya Disease
Functional Outcomes After Revascularization Procedures in Patients With Hemorrhagic Moyamoya Disease
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DOI：
10.1093/neuros/nyz074
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发表时间：
2020-02-01
期刊：
影响因子：
4.8
通讯作者：
Steinberg, Gary K.
中科院分区：
文献类型：
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作者：
Abhinav, Kumar;Furtado, Sunil, V;Steinberg, Gary K.
背景出血性烟雾病（MMD）的自然病史差与32%至61%的高再出血率有关。血运重建后，再出血率据报道下降到12%至17%.OBJECTIVE评估长期的功能结果和再出血率出血性MMD患者接受手术血运重建治疗，并检查这些与临床和放射学factors.METHODS患者手术治疗出血性MMD超过26年的时间内确定。使用改良兰金量表（mRS）评估就诊时的临床状态和功能结局。多变量回归分析，以评估与再出血率和功能outcomes.Results的危险因素，共104例（平均年龄：38.04岁）。基线时的平均mRS评分为1.3。其中颞浅动脉-大脑中动脉直接搭桥157侧（91.3%），间接搭桥172侧。在平均61.4个月的随访中，104例患者中有8例（7.7%）发生再出血，每人年再出血率为1.9%。共有4例患者死亡，其中1例与再出血有关。末次随访时，平均mRS评分改善至1.1。未发现与再出血率相关的显著危险因素（P <0.05）。患者的初始mRS评分与最终随访时的mRS评分呈正相关（P <0.001）。STA-MCA直接旁路与更好的性能状态相关（P = 0.033）。结论出血性MMD患者手术血运重建后的再出血率为7.7%，与更高的自然病史率相比较低。手术血运重建改善了患者的体能状态。这些结局支持首选直接STA-MCA旁路进行血运重建手术。
BACKGROUND Poor natural history of hemorrhagic Moyamoya disease (MMD) is related to high rehemorrhage rates between 32% and 61%. Postrevascularization, rehemorrhage rates reportedly decrease to 12% to 17%.OBJECTIVE To evaluate long-term functional outcomes and rehemorrhage rates of hemorrhagic MMD patients treated with surgical revascularization and examine these in relation to clinical and radiological factors.METHODS Patients treated surgically for hemorrhagic MMD over a 26-yr period were identified. Modified Rankin scale (mRS) was used to assess clinical status at presentation and functional outcomes. Multivariable regression analyses were performed to evaluate the risk factors associated with rehemorrhage rates and functional outcomes.RESULTS A total of 104 patients (mean age: 38.04 yr) were identified. The mean mRS score at baseline was 1.3. Of 172 revascularized hemispheres, 157 (91.3%) were direct superficial temporal artery (STA)-middle cerebral artery (MCA) bypasses and the rest indirect. Over the mean follow-up of 61.4 mo, 8 of 104 patients (7.7%) experienced rehemorrhage with rehemorrhage rate per person-years of 1.9%. A total of 4 patients died with 1 related to rehemorrhage. At the last follow-up, mean mRS score improved to 1.1. No significant risk factors were identified in relation to the rehemorrhage rates (P < .05). The patients' initial mRS score was positively associated with mRS scores at the final follow-up (P < .001). STA-MCA direct bypass was associated with better performance status (P = .033).CONCLUSION Rehemorrhage rate following surgical revascularization of the hemorrhagic MMD patients at 7.7% is lower compared with much higher natural history rates. Surgical revascularization improved patients' performance status. These outcomes support performing revascularization procedure with a preference for direct STA-MCA bypasses.