Gross Bradley A, Thomas Ajith J, Frerichs Kai U
Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA,
Neurosurg Rev. 2014 Oct;37(4):579-83. doi: 10.1007/s10143-014-0542-x. Epub 2014 Apr 3.
Moyamoya is a rare though important source of neurological morbidity as a result of both ischemic and hemorrhagic sequelae. Although a litany of series detailing the endovascular management of cerebral ischemia is present in the literature, only a paucity of such reports exists for moyamoya. A systematic review of the literature was performed for patients with moyamoya managed with endovascular techniques in addition to the contribution of an additional case managed at our institution. We evaluated treatment approach (angioplasty and/or stent), complications, and both angiographic and clinical outcomes at last follow-up. Results from a total of 28 endovascular procedures were collected (11 stenting, 17 angioplasty alone). Procedural success, defined as a lack of both angiographic and clinical recurrence at follow-up, was achieved after seven procedures (25 %). This rate did not significantly differ between disease type (moyamoya disease vs moyamoya syndrome, p = 1.0) and treatment approach (angioplasty alone vs stenting, p = 1.0). The overall monthly angiographic and clinical recurrence rates were 9.3 and 8.0 %, respectively. Clinically devastating intracerebral hemorrhage was seen after two procedures (7 %), and in an additional three procedures, the treated vessel could not be effectively dilated (11 %). There is no evidence that angioplasty or stenting improves the natural history of moyamoya. Both are associated with significant rates of early angiographic and/or clinical recurrence of symptoms. Taken with the risk of procedural complications, the current limited data should advise against attempted endovascular treatment of moyamoya.
烟雾病是一种罕见但重要的神经疾病病因，可导致缺血性和出血性后遗症。尽管文献中有大量关于脑缺血血管内治疗的系列报道，但关于烟雾病的此类报道却很少。我们对文献进行了系统回顾，纳入了采用血管内技术治疗的烟雾病患者，并补充了我们机构治疗的一例病例。我们评估了治疗方法（血管成形术和/或支架置入术）、并发症以及最后一次随访时的血管造影和临床结果。共收集了28例血管内手术的结果（11例支架置入术，17例单纯血管成形术）。七例手术（25%）获得了手术成功，定义为随访时血管造影和临床均无复发。该比率在疾病类型（烟雾病与烟雾综合征，p = 1.0）和治疗方法（单纯血管成形术与支架置入术，p = 1.0）之间无显著差异。总体每月血管造影和临床复发率分别为9.3%和8.0%。两例手术（7%）后出现了临床上具有毁灭性的脑出血，另外三例手术（11%）中治疗的血管未能有效扩张。没有证据表明血管成形术或支架置入术能改善烟雾病的自然病程。两者均与早期血管造影和/或临床症状复发的高发生率相关。考虑到手术并发症的风险，目前有限的数据不建议尝试对烟雾病进行血管内治疗。
