Lucia Kristin, Acker Güliz, Rubarth Kerstin, Beyaztas Defne, Vajkoczy Peter
Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Department of Neurosurgery, Goethe University Hospital Frankfurt Am Main, Schleusenweg 2-16, 60528 Frankfurt Am Main, Germany.
J Clin Med. 2023 Jun 23;12(13):4219. doi: 10.3390/jcm12134219.
Patients with Moyamoya Angiopathy (MMA) display structurally altered vessels with decreased cerebral autoregulatory capacity, so aggressive lowering of systemic hypertension may aggravate ischemic symptoms, whereas uncontrolled hypertension may promote hemorrhage. This study provides an in-depth analysis of the role of hypertension in adult MMA patients including long-term analysis of clinical and radiological development. In this single-center retrospective analysis of 137 adult MMA patients with 206 surgically treated hemispheres angiographic images, clinical/operative data were reviewed and scored. Univariate Cox-regression analysis was performed to evaluate hypertension as a predictor for negative angiographic and clinical outcomes following revascularization surgery. A total of 50% of patients were being treated for hypertension prior to the first surgery. Patients with and without hypertension did not differ in terms of age, gender, diagnosis, symptom onset or disease severity (Berlin and Suzuki Grades). Although hypertension did not statistically significantly affect postoperative collaterals, moyamoya vessels or STA-MCA bypass patency, patients with hypertension showed higher rates of bypass patency and better bypass filling compared to those without hypertension. No significant differences in adverse events were found in patients with and without systemic hypertension and the presence of systemic hypertension was not found to predict negative clinical or radiological outcomes. In conclusion, the rate of systemic hypertension in MMA patients appears to be higher than the general population; however, this is not associated with an increased risk of postoperative complications or negative angiographic development following revascularization procedures. Systemic hypertension may also positively influence the rate of bypass patency and filling following revascularization procedures.
烟雾病血管病（MMA）患者的血管结构改变，脑自动调节能力下降，因此积极降低系统性高血压可能会加重缺血症状，而未控制的高血压可能会促进出血。本研究深入分析了高血压在成年MMA患者中的作用，包括对临床和影像学发展的长期分析。在这项对137例成年MMA患者、206个接受手术治疗的半球的血管造影图像进行的单中心回顾性分析中，对临床/手术数据进行了审查和评分。进行单因素Cox回归分析，以评估高血压作为血运重建术后血管造影和临床不良结局的预测指标。共有50%的患者在首次手术前接受高血压治疗。有高血压和无高血压的患者在年龄、性别、诊断、症状发作或疾病严重程度（柏林和铃木分级）方面无差异。虽然高血压在统计学上对术后侧支血管、烟雾状血管或STA-MCA搭桥通畅性没有显著影响，但与无高血压的患者相比，有高血压的患者搭桥通畅率更高，搭桥充盈更好。在有和没有系统性高血压的患者中，不良事件没有显著差异，并且未发现系统性高血压的存在可预测不良的临床或影像学结局。总之，MMA患者的系统性高血压发生率似乎高于一般人群；然而，这与血运重建术后并发症风险增加或血管造影不良发展无关。系统性高血压也可能对血运重建术后的搭桥通畅率和充盈率产生积极影响。
