Pettersson Samuel D, Olofsson Hanna K L, Ali Shan, Szarek Dariusz, Miękisiak Grzegorz, Ogilvy Christopher S
Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland; Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland.
World Neurosurg. 2023 May;173:146-157.e14. doi: 10.1016/j.wneu.2023.01.034. Epub 2023 Jan 28.
Patients who undergo revascularization surgery for moyamoya disease may develop postoperative ischemic stroke (pIS). Several studies have sought to identify risk factors; however, the findings remain highly inconsistent.
PubMed, Scopus, and Web of Science were used to extract references. The first phase of screening required the studies to be in English, involve patients surgically treated for moyamoya disease, and report pIS. The second phase required the studies to provide ≥10 patients and include a control group.
All 22 studies were rated as high quality. Univariate analysis identified pediatrics <3 years of age as a risk factor for pIS (odds ratio [OR], 7.60; P < 0.0001). Among adult patients only, diabetes (OR, 2.10; P = 0.005), a Suzuki grade greater than 3 (OR, 1.74; P = 0.005), mean intraoperative systolic blood pressure (OR, 1.04; P < 0.0001), mean intraoperative diastolic blood pressure (OR, 1.04; P = 0.002), and revascularization in the left hemisphere (OR, 2.09; P = 0.001) were risk factors. Among both age groups, preoperative ischemic stroke (OR, 2.59; P < 0.00001) was a risk factor for pIS. Additionally, perioperative antiplatelet drug administration was a protective factor for specifically acute postoperative white thrombus among adult patients (OR, 0.35; P = 0.002).
In addition to the methods discussed that can mitigate the risk of pIS, the risk factors identified in our analysis may be of great value among surgeons for identifying high-risk patients in order to apply prophylactic measures, as well as scheduling longer and more frequent follow-up visits.
接受烟雾病血运重建手术的患者可能会发生术后缺血性卒中（pIS）。多项研究试图确定风险因素；然而，研究结果仍高度不一致。
使用PubMed、Scopus和Web of Science检索参考文献。筛选的第一阶段要求研究为英文，涉及接受烟雾病手术治疗的患者，并报告pIS。第二阶段要求研究提供≥10例患者并包括一个对照组。
所有22项研究均被评为高质量。单因素分析确定3岁以下儿童是pIS的一个风险因素（比值比[OR]，7.60；P<0.0001）。仅在成年患者中，糖尿病（OR，2.10；P=0.005）、铃木分级大于3级（OR，1.74；P=0.005）、术中平均收缩压（OR，1.04；P<0.0001）、术中平均舒张压（OR，1.04；P=0.002）以及左半球血运重建（OR，2.09；P=0.001）是风险因素。在两个年龄组中，术前缺血性卒中（OR，2.59；P<0.00001）是pIS的一个风险因素。此外，围手术期使用抗血小板药物是成年患者术后急性白色血栓的一个保护因素（OR，0.35；P=0.002）。
除了所讨论的可减轻pIS风险的方法外，我们分析中确定的风险因素对于外科医生识别高危患者以采取预防措施以及安排更长时间和更频繁的随访可能具有重要价值。
