Effect of direct arterial bypass on the prevention of future stroke in patients with the hemorrhagic variety of moyamoya disease
Effect of direct arterial bypass on the prevention of future stroke in patients with the hemorrhagic variety of moyamoya disease
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DOI：
10.3171/jns.2000.93.3.0397
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发表时间：
2000-09-01
影响因子：
4.1
通讯作者：
Sakaki, T
中科院分区：
文献类型：
--
作者：
Kawaguchi, S;Okuno, S;Sakaki, T
物体。通过与间接搭桥术和保守治疗的比较，评价颞浅动脉-大脑中动脉(STA-MCA)搭桥术在预防出血性烟雾病患者未来卒中(包括再出血或缺血事件)中的作用。22名患有出血性烟雾病但没有动脉瘤的患者组成了研究组。在最初的出血发作后，检查了这些患者的治疗和临床病程的临床图表。患者平均年龄43岁，随访期0.8~15.1年，平均8年。保守治疗11例(50%)。手术治疗的11例患者中，6例(27%)行STA-MCA搭桥术，5例(23%)行脑十二指肠动脉闭塞(EDAS)手术。9名患者(41%)在随访期内出现了缺血或再出血事件。接受STA-MCA搭桥术的患者未来卒中事件的发生率显著低于接受保守治疗或接受EDAS治疗的患者(p<；0.05)。Kaplan-Meier图比较了直接搭桥术和保守或间接搭桥术患者的卒中缓解时间，结果显示，直接搭桥术与保守或间接搭桥术的患者相比有显著差异(p<；0.05)。本研究从统计学上证实了STA-MCA搭桥术对预防出血性烟雾病患者再出血或缺血事件的作用。
Object. The authors evaluated the effects of superficial temporal artery-middle cerebral artery (STA-MCA) bypass in the prevention of future stroke, including rebleeding or an ischemic event, in patients suffering from hemorrhagic moyamoya disease by comparing this method with indirect bypass and conservative treatment.Methods. Twenty-two patients who had hemorrhagic moyamoya disease but no aneurysm comprised the study group. These patients' clinical charts were examined with respect to their treatment and clinical course after an initial hemorrhagic episode. The mean age of the patients was 43 years and the follow-up period ranged from 0.8 to 15.1 years, with a mean of 8 years. Eleven patients (50%) were conservatively treated. Among the 11 patients who were surgically treated, STA-MCA bypass was performed in six patients (27%) and encephaloduroarteriosynangiosis (EDAS) in the other five patients (23%). Nine patients (41%) presented with an ischemic or rebleeding event during the follow-up period. The incidence of future stroke events in patients who had undergone an STA-MCA bypass was significantly lower (p < 0.05) than that in patients who had been treated conservatively or with EDAS. Kaplan-Meier plots comparing stroke-free times in patients treated with direct bypass and those in patients who conservatively or with indirect bypass showed a significant difference (p < 0.05) in favor of direct bypass.Conclusions. The effect of STA-MCA bypass on the prevention of recurrent hemorrhage or an ischemic event in patients with hemorrhagic moyamoya disease has been statistically confirmed in this study.