根据病理生理学对莫亚莫亚血管病进行个体化评估:在外科血管再通手术中的应用。

IF 4.4 1区 医学 Q1 CLINICAL NEUROLOGY Stroke and Vascular Neurology Pub Date : 2024-06-21 DOI:10.1136/svn-2023-002464
Xin Zhang, Yu Lei, Jiabin Su, Chao Gao, Yanjiang Li, Rui Feng, Ding Xia, Peng Gao, Yuxiang Gu, Ying Mao
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引用次数: 0

摘要

背景:虽然搭桥手术是治疗莫亚莫亚血管病(MMV)的有效方法,但术后并发症的发生率仍然很高。本研究旨在引入基于 MMV 个体化病理生理学的新型评估系统,并评估其临床意义:这项多中心、前瞻性研究于 2021 年 3 月至 2022 年 2 月间在中国复旦大学附属华山医院和国家神经疾病中心招募了 MMV 成年患者。多模态神经影像包含结构和功能信息,用于评估个性化的疾病严重程度,并通过融合定位手术区域、避开无效区域和提出备选受体动脉。术中通过评估区域血流动力学和电生理学信息进一步选择受体动脉。对吻合前和吻合后的数据进行比较,以协助术后管理。接受这种量身定制的血管重建术的患者被纳入新型组,其他患者被纳入传统组。比较了30天的手术结果和中期长期随访结果:结果:共纳入 375 例患者(新型组 145 例,传统组 230 例)。新型组的总体并发症发生率明显较低(p˂0.001)。具体而言,术后梗死(p=0.009)和高灌注综合征(p=0.010)的发生率均明显降低。新颖组的功能预后有更好的趋势,但不明显(P=0.260)。值得注意的是,新颖组功能状态良好的比例更高(P=0.009)。有趣的是,旁路区域周围的术前灌注和代谢状态与术后并发症的发生有显著相关性(P˂0.0001):这一新型评估系统有助于在 MMV 搭桥手术中确定合适的手术区域和受体动脉,以实现更好的血流动力学重塑和病理生理改善,从而获得更有利的临床结果。
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Individualised evaluation based on pathophysiology for moyamoya vasculopathy: application in surgical revascularisation.

Background: Although bypass surgery is an effective treatment for moyamoya vasculopathy (MMV), the incidence of postoperative complications is still high. This study aims to introduce a novel evaluating system based on individualised pathophysiology of MMV, and to assess its clinical significance.

Methods: This multicentre, prospective study enrolled adult patients with MMV from Huashan Hospital, Fudan University and National Center for Neurological Disorders, China between March 2021 and February 2022. Multimodal neuroimages containing structural and functional information were used to evaluate personalised disease severity and fused to localise the surgical field, avoid invalid regions and propose alternative recipient arteries. The recipient artery was further selected intraoperatively by assessing regional haemodynamic and electrophysiological information. The preanastomosis and postanastomosis data were compared with assist with the postoperative management. Patients who received such tailored revascularisations were included in the novel group and the others were included in the traditional group. The 30-day surgical outcomes and intermediate long-term follow-up were compared.

Results: Totally 375 patients (145 patients in the novel group and 230 patients in the traditional group) were included. The overall complication rate was significantly lower in the novel group (p˂0.001). In detail, both the rates of postoperative infarction (p=0.009) and hyperperfusion syndrome (p=0.010) were significantly lower. The functional outcomes trended to be more favourable in the novel group, though not significantly (p=0.260). Notably, the proportion of good functional status was higher in the novel group (p=0.009). Interestingly, the preoperative statuses of perfusion and metabolism around the bypass area were significantly correlated with the occurrence of postoperative complications (P˂0.0001).

Conclusions: This novel evaluating system helps to identify appropriate surgical field and recipient arteries during bypass surgery for MMV to achieve better haemodynamic remodelling and pathophysiological improvement, which results in more favourable clinical outcomes.

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来源期刊
Stroke and Vascular Neurology
Stroke and Vascular Neurology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
11.20
自引率
1.70%
发文量
63
审稿时长
15 weeks
期刊介绍: Stroke and Vascular Neurology (SVN) is the official journal of the Chinese Stroke Association. Supported by a team of renowned Editors, and fully Open Access, the journal encourages debate on controversial techniques, issues on health policy and social medicine.
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