Lu Mingming, Zhang Hongtao, Liu Shitong, Liu Yuan, Li Baobao, Hao Fangbin, Peng Peng, Sheng Fugeng, Zhao Xihai, Yuan Fei, Han Cong, Cai Jianming
Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China.
Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China.
Eur Radiol. 2025 Apr 11. doi: 10.1007/s00330-025-11562-9.
To evaluate the role of vessel wall enhancement in the efficacy of antiplatelet therapy (APT) on reducing the stroke risk in patients with Moyamoya disease (MMD) based on postcontrast MR vessel wall imaging.
Consecutive patients with MMD underwent postcontrast MR vessel wall imaging and were divided into APT and non-APT groups according to the prescribed antiplatelet agents. Kaplan-Meier survival and Cox regression analyses were performed to determine the association between APT and stroke risk of patients with MMD, and subgroup analysis was performed to determine the role of vessel wall enhancement in reducing stroke risk after APT.
A total of 1262 patients (mean age: 42.6 ± 11.1 years) were finally included for analysis. Compared with patients without APT, those with APT were older (p = 0.023) and had a higher incidence of hypertension (p = 0.015), and with advanced Suzuki stage (≥ IV) (p < 0.001). During an average follow-up of 37.9 months, patients without APT had a marginally greater incidence of cerebrovascular events (12.9% vs. 9.7%; HR p = 0.069) than those who underwent APT before and after propensity score matching. The subgroup analyses revealed that vessel wall enhancement had a significant interaction effect on the association between APT and stroke outcomes, and APT could significantly reduce stroke risk in MMD patients with vessel wall enhancement (HR = 0.43; 95% CI: 0.23-0.79, interaction p = 0.038).
APT may significantly reduce stroke risk in patients with MMD with vessel wall enhancement.
Question The effect of antiplatelet therapy (APT) varies in patients with moyamoya disease (MMD). Findings APT may significantly reduce stroke risk for MMD patients with vessel wall enhancement. Clinical relevance Post-contrast high-resolution MRI may help identify MMD patients who would mostly benefit from APT; APT should be highly recommended in MMD patients with vessel wall enhancement.
基于对比增强磁共振血管壁成像，评估血管壁强化在烟雾病（MMD）患者抗血小板治疗（APT）降低卒中风险疗效中的作用。
连续纳入接受对比增强磁共振血管壁成像的MMD患者，并根据所开具的抗血小板药物分为APT组和非APT组。采用Kaplan-Meier生存分析和Cox回归分析来确定APT与MMD患者卒中风险之间的关联，并进行亚组分析以确定血管壁强化在APT后降低卒中风险中的作用。
最终共纳入1262例患者（平均年龄：42.6±11.1岁）进行分析。与未接受APT的患者相比，接受APT的患者年龄更大（p = 0.023），高血压发病率更高（p = 0.015），且铃木分期更晚（≥IV期）（p < 0.001）。在平均37.9个月的随访期间，倾向评分匹配前后，未接受APT的患者脑血管事件发生率略高于接受APT的患者（12.9%对9.7%；HR p = 0.069）。亚组分析显示，血管壁强化对APT与卒中结局之间的关联有显著的交互作用，APT可显著降低血管壁强化的MMD患者的卒中风险（HR = 0.43；95%CI：0.23 - 0.79，交互作用p = 0.038）。
APT可能显著降低血管壁强化的MMD患者的卒中风险。
问题抗血小板治疗（APT）在烟雾病（MMD）患者中的效果各异。发现APT可能显著降低血管壁强化的MMD患者的卒中风险。临床意义对比增强高分辨率MRI可能有助于识别最能从APT中获益的MMD患者；对于血管壁强化的MMD患者，应强烈推荐APT。
