Zhao Yahui, Zhang Qian, Zhang Dong, Zhao Yuanli
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2017 Sep;105:728-731. doi: 10.1016/j.wneu.2017.06.057. Epub 2017 Jun 15.
Aspirin has been implicated in the postoperative management of moyamoya disease (MMD) in order to avoid bypass failure and decrease the incidence of subsequent stroke. However, its effect has not been completely determined yet.
In this study, we retrospectively reviewed data of 184 adult patients (197 hemispheres) presented with ischemic-onset MMD who had undergone direct or combined revascularization in our hospital, to clarify the effect of postoperative aspirin therapy in the management of moyamoya disease. Fifty-nine hemispheres that had been administered with aspirin (100 mg/day) after bypass surgery were defined as the "aspirin group," whereas 138 that hadn't been given aspirin postoperatively were defined as the "control group".
Among 197 hemispheres, the mortality rate was 0. The incidence of postoperative newly developed infarction, transient ischemic attack, and hemorrhage were not significantly different between the aspirin and control groups. The patency rate of bypass graft was not significantly different between the groups, either. Notably, more patients experienced major stroke in the control group (9/138) than the aspirin group (1/59), but no statistical difference was found (P > 0.05). In the aspirin group, more patients had improved outcome than the control group (P = 0.04).
Our findings showed that aspirin might not decrease the incidence of postoperative ischemic stroke or increase patency rate of bypass graft, but it does not increase the risk of hemorrhages, either. Also, postoperative aspirin therapy might improve outcome. More studies are needed to provide evidence for postoperative antiplatelet therapy in MMD management.
阿司匹林已被应用于烟雾病（MMD）的术后管理，以避免搭桥失败并降低后续中风的发生率。然而，其效果尚未完全确定。
在本研究中，我们回顾性分析了我院184例缺血性起病的烟雾病成年患者（197个半球）的数据，这些患者接受了直接或联合血管重建术，以明确术后阿司匹林治疗在烟雾病管理中的效果。59个在搭桥手术后接受阿司匹林（100毫克/天）治疗的半球被定义为“阿司匹林组”，而138个术后未接受阿司匹林治疗的半球被定义为“对照组”。
在197个半球中，死亡率为0。阿司匹林组和对照组术后新发梗死、短暂性脑缺血发作和出血的发生率无显著差异。两组间搭桥血管的通畅率也无显著差异。值得注意的是，对照组（9/138）发生严重中风的患者比阿司匹林组（1/59）多，但未发现统计学差异（P>0.05）。在阿司匹林组中，改善结局的患者比对照组多（P = 0.04）。
我们的研究结果表明，阿司匹林可能不会降低术后缺血性中风的发生率或提高搭桥血管的通畅率，但也不会增加出血风险。此外，术后阿司匹林治疗可能会改善结局。需要更多研究为烟雾病管理中的术后抗血小板治疗提供证据。
