Newman Sarah, McMahon J Tanner, Boulter Jason H, Malcolm James G, Revuelta Barbero Juan M, Chern Joshua J, Barrow Daniel L, Pradilla Gustavo
Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
Emory University School of Medicine, Atlanta, Georgia, USA.
Neurosurgery. 2022 Apr 1;90(4):441-446. doi: 10.1227/NEU.0000000000001847.
Moyamoya syndrome refers to a progressive stenosis of the internal carotid arteries and can be associated with sickle cell disease. These codiagnoses result in severe risk for stroke, even in patients on optimal medical management. Surgical revascularization has been shown to be safe in small case series.
To evaluate the efficacy of revascularization with direct comparison to a medically managed control group within a single institution.
A retrospective cohort study of medically managed vs surgically revascularized patients with moyamoya syndrome and sickle cell disease was conducted. Demographic data and outcomes including the number of prediagnosis, postdiagnosis, and postrevascularization strokes were collected. Risk factors for stroke were identified using a binary logistic regression model, and stroke rates and mortality between groups were compared.
Of the 29 identified patients, 66% were medically managed and 34% underwent surgical revascularization (50% direct and 50% indirect). Calculated stroke rates were 1 per 5.37 (medical management), 1 per 3.43 (presurgical revascularization), and 1 per 23.14 patient-years (postsurgical revascularization). There was 1 surgical complication with no associated permanent deficits. No risk factors for stroke after time of diagnosis were found to be significant.
The results of this study demonstrate that revascularization is associated with a significant reduction in stroke risk, both relative to prerevascularization rates and compared with medical management. According to these findings, surgical revascularization offers a safe and durable preventative therapy for stroke and should be pursued aggressively in this patient population.
烟雾病综合征指颈内动脉进行性狭窄，可与镰状细胞病相关。这些共病诊断即使在接受最佳药物治疗的患者中也会导致严重的中风风险。在小病例系列研究中，手术血运重建已被证明是安全的。
在单一机构内，通过与药物治疗对照组直接比较，评估血运重建的疗效。
对烟雾病综合征和镰状细胞病患者进行药物治疗与手术血运重建的回顾性队列研究。收集人口统计学数据和结果，包括诊断前、诊断后和血运重建后中风的次数。使用二元逻辑回归模型确定中风的危险因素，并比较两组之间的中风发生率和死亡率。
在29名确诊患者中，66%接受药物治疗，34%接受手术血运重建（50%为直接手术，50%为间接手术）。计算得出的中风发生率分别为每5.37人年1例（药物治疗）、每3.43人年1例（术前血运重建）和每23.14人年1例（术后血运重建）。有1例手术并发症，无相关永久性缺陷。未发现诊断后中风的危险因素具有显著性。
本研究结果表明，与血运重建前的发生率相比以及与药物治疗相比，血运重建与中风风险的显著降低相关。根据这些发现，手术血运重建为中风提供了一种安全且持久的预防性治疗，应在该患者群体中积极推行。
