Moussouttas Michael, Rybinnik Igor
Department of Neurology, Cerebrovascular Division, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ 08901, USA.
Department of Neurology, Cerebrovascular Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Ther Adv Neurol Disord. 2020 May 26;13:1756286420921092. doi: 10.1177/1756286420921092. eCollection 2020.
Moyamoya disease (MMD) is a complex cerebrovascular disorder about which little is known. Conventionally, revascularization surgery is recommended for patients, despite an absence of conclusive data from adequate clinical trials. Underscoring the uncertainty that exists in treating MMD patients, investigators continue to present data comparing revascularization with conservative or medical management, most of which originates from East Asia where MMD is most prevalent. The purpose of this manuscript is to review contemporary large case series, randomized trials, and recent meta-analyses that compare surgical and medical treatments in adult patients with MMD, and to critically analyze the modern literature in the context of current practice standards. Data from the available literature is limited, but revascularization seems superior to conservative therapy in adult patients presenting with hemorrhage, and in preventing future hemorrhages. Conversely, evidence that surgery is superior to medical therapy is not convincing in adult patients presenting with cerebral ischemia, or for the prevention of future ischemic events. In contrast to East Asian populations, MMD in Europe and in the Americas is predominantly an ischemic disease that presents in adulthood. Adequate multinational trials are warranted.
烟雾病（MMD）是一种复杂的脑血管疾病，目前人们对其了解甚少。按照惯例，尽管缺乏充分临床试验的确凿数据，但仍建议患者进行血管重建手术。由于治疗烟雾病患者存在不确定性，研究人员继续提供将血管重建与保守或药物治疗进行比较的数据，其中大部分来自烟雾病最为普遍的东亚地区。本手稿的目的是回顾当代大型病例系列、随机试验以及最近比较烟雾病成年患者手术和药物治疗的荟萃分析，并根据当前的实践标准对现代文献进行批判性分析。现有文献的数据有限，但在出现出血的成年患者中，血管重建似乎优于保守治疗，并且在预防未来出血方面也是如此。相反，在出现脑缺血的成年患者中，或者在预防未来缺血事件方面，手术优于药物治疗的证据并不令人信服。与东亚人群不同，欧洲和美洲的烟雾病主要是成年期出现的缺血性疾病。有必要进行充分的跨国试验。
