Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Neurosurg Rev. 2020 Apr;43(2):609-617. doi: 10.1007/s10143-019-01086-4. Epub 2019 Feb 14.
Extracranial-to-intracranial (EC-IC) bypass surgery is an effective treatment for patients with moyamoya disease and other conditions. Some patients with moyamoya disease have a risk of acute thrombogenesis at the anastomotic site just after bypass surgery. The purpose of this study was to study risk factors of acute thrombogenesis and determine effective countermeasures. This study included 48 patients (66 EC-IC bypass procedures) with moyamoya disease and 52 controls (54 procedures) without moyamoya disease. The development of acute thrombogenesis was compared between the moyamoya disease and control groups. In the moyamoya disease group, clinical and radiological characteristics were assessed with respect to acute thrombogenesis. In the patients with acute thrombogenesis, causes of technical problems were retrospectively examined. The incidence of acute thrombogenesis was significantly higher in the moyamoya disease group than those in the control group. In the moyamoya disease group, acute thrombogenesis was observed in seven patients. In the moyamoya disease group, the magnetic resonance angiography (MRA) scores were significantly higher in patients with acute thrombogenesis than those in the patients without acute thrombogenesis. In the multivariate analysis, the predictive factor of acute thrombogenesis in moyamoya disease was a high MRA score (odds ratio, 2.336; p = 0.009). During EC-IC bypass surgery for moyamoya disease, acute thrombogenesis should be considered to obtain a high patency rate, particularly in patients with high MRA scores. Acute thrombogenesis will not influence morbidity if proper countermeasures are followed; therefore, the prediction and recognition of white thrombus are important for a successful bypass surgery.
颅外-颅内（EC-IC）旁路手术是治疗烟雾病和其他疾病的有效方法。一些烟雾病患者在旁路手术后吻合口处有急性血栓形成的风险。本研究旨在研究急性血栓形成的危险因素，并确定有效的对策。本研究纳入了 48 例（66 例 EC-IC 旁路手术）烟雾病患者和 52 例（54 例手术）无烟雾病患者。比较了烟雾病组和对照组急性血栓形成的发生情况。在烟雾病组，评估了与急性血栓形成相关的临床和影像学特征。在发生急性血栓形成的患者中，回顾性检查了技术问题的原因。烟雾病组急性血栓形成的发生率明显高于对照组。在烟雾病组，7 例患者发生急性血栓形成。在烟雾病组，发生急性血栓形成的患者磁共振血管造影（MRA）评分明显高于未发生急性血栓形成的患者。多因素分析显示，烟雾病患者急性血栓形成的预测因素是 MRA 评分高（比值比，2.336；p=0.009）。在烟雾病的 EC-IC 旁路手术中，为获得高通畅率，应考虑急性血栓形成，尤其是 MRA 评分高的患者。如果采取适当的对策，急性血栓形成不会影响发病率；因此，对白血栓的预测和识别对于成功的旁路手术很重要。
