Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Aichi Rehabilitation Hospital, Nishio, Japan.
Acta Neurochir (Wien). 2021 May;163(5):1485-1491. doi: 10.1007/s00701-020-04668-0. Epub 2021 Jan 6.
When superficial temporal artery-middle cerebral artery bypass is combined with indirect methods (e.g., revascularization surgery) to treat Moyamoya disease (MMD), antiplatelet treatment can impact bypass patency, infarction, or hemorrhage complications. Recently, heparin has been proposed as an anticoagulant treatment against white thrombus at the anastomosis site. The study aims to evaluate the effect of aspirin on the perioperative outcomes and investigate the results of heparin treatment for white thrombus.
This retrospective study included 74 procedures of combined revascularization surgery for MMD patients who either received or did not receive aspirin. Perioperative outcomes were compared between the two groups. In addition, the effects of heparin treatment for white thrombus were evaluated.
The rate of white thrombus at the anastomosis site was significantly higher in the non-aspirin medication group (univariate: p = 0.032, multivariate: p = 0.044) and, accordingly, initial bypass patency was lower in the non-aspirin medication group (p = 0.049). Of the 17 patients with white thrombus development, five received heparin injections, and all white thrombi disappeared; however, there was one case of epidural hematoma and another of subdural hematoma. The risk of hemorrhagic complications was significantly higher in the surgical procedures that received heparin injections (p = 0.021).
In MMD patients who received combined revascularization surgery, aspirin medication lowered the occurrence of white thrombus. Heparin injections help to treat white thrombus but can enhance the risk of hemorrhagic complications.
当颞浅动脉-大脑中动脉搭桥术与间接方法（例如，血运重建手术）联合用于治疗烟雾病（MMD）时，抗血小板治疗会影响搭桥通畅率、梗死或出血并发症。最近，肝素已被提议作为一种抗凝剂，用于对抗吻合部位的白色血栓。本研究旨在评估阿司匹林对围手术期结局的影响，并探讨肝素治疗白色血栓的结果。
本回顾性研究纳入了 74 例接受或未接受阿司匹林治疗的联合血运重建手术治疗 MMD 患者的手术。比较了两组患者的围手术期结局。此外，还评估了肝素治疗白色血栓的效果。
非阿司匹林用药组吻合部位白色血栓发生率明显更高（单因素：p = 0.032，多因素：p = 0.044），因此非阿司匹林用药组初始搭桥通畅率较低（p = 0.049）。在 17 例出现白色血栓的患者中，5 例接受肝素注射治疗，所有白色血栓均消失，但有 1 例出现硬膜外血肿，另 1 例出现硬膜下血肿。接受肝素注射治疗的手术发生出血性并发症的风险显著更高（p = 0.021）。
在接受联合血运重建手术的 MMD 患者中，阿司匹林用药降低了白色血栓的发生。肝素注射有助于治疗白色血栓，但会增加出血性并发症的风险。
