Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China.
Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China; Department of Neurosurgery, 307th Hospital of People's Liberation Army, 307 Clinical College, Anhui Medical University, Beijing, China.
World Neurosurg. 2018 Jul;115:e482-e489. doi: 10.1016/j.wneu.2018.04.076. Epub 2018 Apr 21.
In adult Moyamoya disease (MMD), there remains controversy about the effectiveness of revascularization surgeries because randomized studies have not been performed to compare the efficacy of surgical techniques. This study was conducted to assess the most appropriate surgical treatment for adult patients with MMD.
Encephaloduroarteriosynangiosis (EDAS) was performed on 247 hemispheres in 145 patients. The clinical and demographic characteristics of patients were obtained via retrospective chart review. Clinical and angiographic states were evaluated retrospectively using quantitative methods. The mean duration of clinical follow up was 141.4 ± 19.5 months.
A total of 247 EDAS procedures were performed in 145 patients, including 15 EDAS performed using the occipital artery as the donor vessel. The mortality rate was 0%, and the permanent morbidity rates were 1.2% per operation and 2.0% per person. The mean modified Rankin Scale score was 1.21 ± 1.31 postoperatively and 1.01 ± 1.39 at the last follow-up. Of the 109 hemispheres studied, 45% were classified as grade A, 34% as grade B, and 21% as grade C collateral circulation. The annual rates of stroke were calculated to be 0.73% per person-year. Overall, the 1-,5-, and 10-year actuarial stroke rates were 2.1±1.2%, 6.8±2.1%, and 8.9±2.4%, respectively. Bilateral involvement was a common significant factor in any, hemorrhagic, and ischemic strokes. Hypertension was a risk factor for ischemic strokes during follow-up.
EDAS is an effective procedure in a Chinese cohort of patients with MMD. EDAS resulted in satisfactory long-term improvement of clinical states and prevention of recurrent strokes.
成人烟雾病（MMD）中，由于尚未开展比较手术技术疗效的随机研究，因此对于血运重建手术的有效性仍存在争议。本研究旨在评估最适合成人 MMD 患者的外科治疗方法。
对 145 例患者的 247 个半脑进行了颅内外血管搭桥术（EDAS）。通过回顾性病历审查获得患者的临床和人口统计学特征。使用定量方法回顾性评估临床和血管造影状态。平均临床随访时间为 141.4±19.5 个月。
在 145 例患者中进行了 247 次 EDAS 手术，其中 15 次手术采用枕动脉作为供体血管。死亡率为 0%，手术永久性并发症发生率为 1.2%/次，患者永久性并发症发生率为 2.0%/人。术后平均改良 Rankin 量表评分为 1.21±1.31，末次随访时为 1.01±1.39。在研究的 109 个半脑中，45%被分类为 A 级，34%为 B 级，21%为 C 级侧支循环。计算得出每年的卒中发生率为 0.73%/人年。总的来说，1、5 和 10 年的累积卒中发生率分别为 2.1±1.2%、6.8±2.1%和 8.9±2.4%。双侧受累是任何、出血性和缺血性卒中的共同重要因素。高血压是随访期间缺血性卒中的危险因素。
EDAS 是中国 MMD 患者的一种有效治疗方法。EDAS 可长期显著改善临床状态并预防复发性卒中。
