Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, Japan.
Department of Neurosurgery, Toyota Kosei Hospital, 500-1 Ibobara, Josui-cho, Toyota City, Aichi, Japan.
Acta Neurochir (Wien). 2021 May;163(5):1493-1502. doi: 10.1007/s00701-021-04773-8. Epub 2021 Feb 23.
Ipsilateral late stroke events occurring after cerebral revascularization for Moyamoya disease (MMD) and their risk factors have not been fully investigated.
We retrospectively analyzed 123 patients with MMD who underwent 212 revascularizations. We investigated preoperative demographic data, surgical procedures, and ipsilateral stroke events occurring more than 1 month after surgery. The effect of revascularization and the residual Moyamoya vessel (MMV) score were examined using magnetic resonance angiography (MRA). Then, predictive factors for postoperative late stroke occurrence were evaluated by logistic regression.
The mean age was 26 ± 18.4 years (range 1 to 66 years). Ipsilateral late stroke events were present in 11 of 123 (9%) patients. Stroke occurred in 11 out of 212 surgeries (5.2%) on a hemispheric basis. During the 1300.1 hemisphere-years of follow-up more than 1 month after surgery, the annual stroke rate was 0.84%. The postoperative MRA time-of-flight image showed a mean revascularization score of 1.82 ± 0.6 and a mean residual MMV score of 1.91 ± 0.83. Postoperative strokes occurring within 1 month after cerebral revascularization (36.4%, p = 0.0026) and lower revascularization scores (1.82 ± 0.6 vs 2.51 ± 0.59, p = 0.0006) were significant factors related to the presence of ipsilateral late stroke. Logistic regression showed that stroke events within 1 month after revascularization (odds ratio [OR], 9.79; 95% confidence interval [CI], 0.02-0.57; p = 0.0103), low revascularization score (OR, 0.15; 95% CI, 0.001-0.37; p = 0.0069), and high residual MMV score (OR, 16.2; 95% CI, 1.88-187.4; p = 0.0107) were risk factors for ipsilateral stroke more than 1 month after revascularization.
MMD patients who have a stroke within 1 month after cerebral revascularization are at high risk for late strokes. Less effective revascularization or remarkable residual MMV are risk factors for late stroke events. Additional revascularization may be considered for patients in such situations.
This study was approved by the Bioethics Review Committee of Nagoya University Hospital for the treatment and prognosis of Moyamoya disease (2016-0327).
大脑血运重建术后发生的同侧迟发性卒中事件及其危险因素在烟雾病（MMD）患者中尚未得到充分研究。
我们回顾性分析了 123 例接受 212 次血运重建的 MMD 患者。我们研究了术前的人口统计学数据、手术过程以及术后 1 个月以上发生的同侧卒中事件。使用磁共振血管造影（MRA）检查血运重建的效果和残余烟雾血管（MMV）评分。然后，通过逻辑回归评估术后迟发性卒中发生的预测因素。
患者平均年龄为 26 ± 18.4 岁（1 至 66 岁）。123 例患者中有 11 例（9%）发生同侧迟发性卒中事件。在 212 次手术中有 11 次（5.2%）发生半球性卒中。在术后 1300.1 个半球年的随访中，术后 1 个月以上的年卒中发生率为 0.84%。术后 MRA 时间飞跃图像显示平均再血管化评分 1.82 ± 0.6，平均残余 MMV 评分 1.91 ± 0.83。脑血运重建术后 1 个月内发生的卒中（36.4%，p=0.0026）和较低的再血管化评分（1.82 ± 0.6 比 2.51 ± 0.59，p=0.0006）是同侧迟发性卒中存在的显著相关因素。逻辑回归显示，血运重建术后 1 个月内的卒中事件（优势比[OR]，9.79；95%置信区间[CI]，0.02-0.57；p=0.0103）、较低的再血管化评分（OR，0.15；95%CI，0.001-0.37；p=0.0069）和较高的残余 MMV 评分（OR，16.2；95%CI，1.88-187.4；p=0.0107）是血运重建后 1 个月以上同侧卒中的危险因素。
脑血运重建术后 1 个月内发生卒中的 MMD 患者发生迟发性卒中的风险较高。效果较差的再血管化或明显残余 MMV 是迟发性卒中事件的危险因素。对于这种情况下的患者，可能需要考虑额外的血运重建。
本研究得到了名古屋大学医院治疗和预后烟雾病生物伦理审查委员会的批准（2016-0327）。
