Lee Yeonhu, Lee Jin Soo, Lee Seong-Joon, Hong Ji Man, Lim Yong Cheol
Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.
Front Neurol. 2024 Dec 23;15:1479379. doi: 10.3389/fneur.2024.1479379. eCollection 2024.
The optimal timing of bypass surgery for patients with moyamoya disease (MMD) or moyamoya syndrome (MMS) following an acute stroke episode remains unclear, mainly owing to the risk of postoperative complications. In this study, we aim to validate the safety and efficacy of early intervention using multiple burr hole (MBH) and erythropoietin (EPO) therapy, thereby refining the management strategy for patients with acute stroke episode of MMD or MMS.
We retrospectively analyzed data from 70 patients with MMD or MMS who underwent MBH and EPO therapy. The cohort was divided based on the time interval between the latest neurological deterioration and surgery: early (<30 days) and later (≥30 days) groups. We evaluated and compared perioperative clinical parameters and the extent of neovascularization on a 6-month postoperative angiography. Long-term clinical outcomes, including transient ischemic attack (TIA), infarction, hemorrhage, and seizure, were also analyzed during the follow-up period.
In the cohort, 36 patients (51.4%) were in the early group, whereas 34 (48.6%) were in the later group. The 6-month follow-up angiography demonstrated that 34/47 hemispheres (72.3%) in the early group exhibited successful neovascularization (≥2/3 of MCA territories) compared with the 19/44 (43.2%) hemispheres in the later group (odds ratio [OR] = 3.44; 95% confidence interval [CI]: 1.46-8.45; < 0.01). In addition, a notable reduction (≥50%) in basal moyamoya vessels was observed in 30/47 hemispheres (63.8%) from the early group vs. 12/44 (27.3%) hemispheres from the later group (OR = 4.71; 95% CI: 1.97-11.82; < 0.001). During the average follow-up of 56.5 months, only six patients experienced infarction or hemorrhage.
Our dataset suggests that MBH and EPO combination therapy is an effective, minimally invasive, and acceptable treatment, even in the early period of patients with MMD or MMS following an acute stroke episode.
烟雾病（MMD）或烟雾综合征（MMS）患者急性卒中发作后旁路手术的最佳时机仍不明确，主要是由于术后并发症的风险。在本研究中，我们旨在验证使用多骨孔（MBH）和促红细胞生成素（EPO）治疗进行早期干预的安全性和有效性，从而完善MMD或MMS急性卒中发作患者的管理策略。
我们回顾性分析了70例接受MBH和EPO治疗的MMD或MMS患者的数据。根据最近一次神经功能恶化与手术之间的时间间隔将队列分为：早期（<30天）和晚期（≥30天）组。我们评估并比较了围手术期临床参数以及术后6个月血管造影时新生血管形成的程度。在随访期间还分析了长期临床结局，包括短暂性脑缺血发作（TIA）、梗死、出血和癫痫发作。
在该队列中，36例患者（51.4%）在早期组，而34例（48.6%）在晚期组。术后6个月的血管造影显示，早期组47个半球中的34个（72.3%）出现了成功的新生血管形成（≥大脑中动脉区域的2/3），而晚期组44个半球中的19个（43.2%）出现了成功的新生血管形成（优势比[OR]=3.44；95%置信区间[CI]：1.46-8.45；P<0.01）。此外，早期组47个半球中的30个（63.8%）观察到基底烟雾血管明显减少（≥50%），而晚期组44个半球中的12个（27.3%）观察到基底烟雾血管明显减少（OR=4.71；95%CI：1.97-11.82；P<0.001）。在平均56.5个月的随访期间，只有6例患者发生梗死或出血。
我们的数据集表明，MBH和EPO联合治疗是一种有效、微创且可接受的治疗方法，即使在MMD或MMS患者急性卒中发作后的早期也是如此。
