Pang Chang Hwan, Lee Sang Hyo, Choi Tae Won, Byoun Hyoung Soo, Kim Young-Deok, Ban Seung Pil, Bang Jae Seung, Kwon O-Ki, Oh Chang Wan, Lee Si Un
1Department of Neurosurgery, Chung-ang University Gwangmyeong Hospital, Gwangmyeong-si.
2Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si; and.
J Neurosurg. 2024 Sep 6;142(3):605-612. doi: 10.3171/2024.5.JNS2411. Print 2025 Mar 1.
This study was designed to identify predictive factors associated with substantial contralateral progression in adult patients with bilateral nonhemorrhagic moyamoya disease (MMD) who undergo revascularization surgery (RS) on one hemisphere.
The authors retrospectively analyzed 174 contralateral hemispheres of patients with bilateral nonhemorrhagic MMD (non-hMMD) who underwent RS on one side. The primary endpoint was defined as substantial contralateral progression requiring additional RS 6 months after the initial RS. The annual risk and predictive factors for contralateral progression were also analyzed.
Of 174 patients included in the study, 57 (32.8%) experienced contralateral progression over a mean follow-up of 45.3 ± 31.6 months (range 12-196 months). The annual risk for contralateral progression after initial unilateral RS was 7.7% per person-year. Multivariable analysis revealed that age (HR 0.967, 95% CI 0.944-0.992; p = 0.009) and a BMI ≥ 25 (HR 1.946, 95% CI 1.126-3.362; p = 0.017) were significant predictors of contralateral progression. Specifically, the annual risk of contralateral progression was 12.1% in the higher BMI (≥ 25) group and 4.0% in the lower BMI (< 25) group per person-year.
The study revealed a 7.7% per person-year rate of contralateral progression in patients with bilateral non-hMMD following unilateral RS. Younger age and a BMI ≥ 25 were identified as significant risk factors. For these patients, careful weight management and the use of antilipid agents may be crucial strategies for reducing the risk of contralateral progression after unilateral RS.
本研究旨在确定在接受一侧半球血运重建手术（RS）的双侧非出血性烟雾病（MMD）成年患者中，与对侧显著进展相关的预测因素。
作者回顾性分析了174例接受一侧RS的双侧非出血性MMD（非hMMD）患者的对侧半球。主要终点定义为在初次RS后6个月需要额外RS的对侧显著进展。还分析了对侧进展的年度风险和预测因素。
在纳入研究的174例患者中，57例（32.8%）在平均45.3±31.6个月（范围12 - 196个月）的随访中出现对侧进展。初次单侧RS后对侧进展的年度风险为每人每年7.7%。多变量分析显示，年龄（HR 0.967，95%CI 0.944 - 0.992；p = 0.009）和BMI≥25（HR 1.946，95%CI 1.126 - 3.362；p = 0.017）是对侧进展的显著预测因素。具体而言，BMI较高（≥25）组对侧进展的年度风险为每人每年12.1%，BMI较低（<25）组为4.0%。
该研究显示，双侧非hMMD患者在单侧RS后对侧进展的发生率为每人每年7.7%。较年轻的年龄和BMI≥25被确定为显著风险因素。对于这些患者，谨慎的体重管理和使用抗脂质药物可能是降低单侧RS后对侧进展风险的关键策略。
