*Department of Neurosurgery, Mayo Clinic Rochester, Rochester, Minnesota; ‡Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida.
Neurosurgery. 2013 Dec;73(6):984-91; discussion 981-2. doi: 10.1227/NEU.0000000000000162.
The majority of moyamoya surgical series have been confined to Asian and pediatric populations. Few have studied demographics, risk factors, and outcomes in adult North American populations.
To examine outcomes after revascularization for moyamoya in white and African American adults and to assess for predictors of recurrent stroke.
A retrospective review of 75 non-Asian patients undergoing 110 procedures at the Mayo Clinic was performed. Demographics, known moyamoya associations, cerebrovascular risk factors, and autoimmune diseases were recorded. Primary outcomes for vascular events were assessed with Kaplan-Meier analysis. Fisher exact methods were used to evaluate for associations with recurrent events.
Mean age was 42 years, and mean follow-up was 47 months. Seventy-one of the 75 patients were white. The majority had bilateral disease (n = 49). Perioperative ischemic events occurred in 5 patients (4.5%). The 5- and 10-year event rates were 5.8% and 9.9%. Significant associations were found with a history of thyroid disease (P = .05) and recurrent stroke. A trend was also found between hypertension and autoimmune disease with recurrent stroke.
Outcomes were favorable with revascularization in this subset with moyamoya. A significant association between a history of thyroid disease and recurrent stroke was found. Additionally, high prevalences of autoimmune disease, hypertension, and thyroid disease were found in our cohort, suggesting that they may play a role in the pathophysiology and progression of moyamoya disease in this population. A new classification for moyamoya is proposed based on these data.
大多数烟雾病手术系列仅限于亚洲和儿科人群。很少有研究涉及成年北美人种的人口统计学、风险因素和结果。
研究白人及非裔美国人烟雾病血管重建术后的结果，并评估复发性卒中的预测因素。
回顾性分析了梅奥诊所的 75 例非亚洲患者的 110 例手术。记录了人口统计学资料、已知的烟雾病相关因素、脑血管危险因素和自身免疫性疾病。采用 Kaplan-Meier 分析评估血管事件的主要结局。采用 Fisher 确切概率法评估与复发性事件的关联。
平均年龄为 42 岁，平均随访时间为 47 个月。75 例患者中 71 例为白人。大多数患者（n = 49）存在双侧疾病。5 例（4.5%）患者发生围手术期缺血性事件。5 年和 10 年的事件发生率分别为 5.8%和 9.9%。有甲状腺疾病史（P =.05）和复发性卒中与显著相关。高血压和自身免疫性疾病与复发性卒中之间也存在趋势性关联。
在这组烟雾病患者中，血管重建术的结果良好。发现有甲状腺疾病史与复发性卒中之间存在显著关联。此外，我们的队列中发现自身免疫性疾病、高血压和甲状腺疾病的患病率较高，这表明它们可能在该人群烟雾病的病理生理学和进展中起作用。基于这些数据，提出了一种新的烟雾病分类。
