成人 moyamoya 病 STA-MCA 分流术后血管造影与临床结果之间的关联。

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-09-11 DOI:10.1177/23969873241278193
Guicheng Kuang, Hang Ji, Jixuan Zheng, Xinchen Li, Kejin Luo, Yajun Hu, Zheyuan Zhang, Haogeng Sun
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引用次数: 0

摘要

背景和目的:作为一种血管造影结果,术后侧支形成(PCF)通常用于评估STA-MCA搭桥术在moyamoya病(MMD)中的效果,但它是否能可靠地反映临床结果仍不清楚。我们研究了 PCF 与成人 MMD 临床预后之间的关系:这项前瞻性队列研究筛选了 2013 年 1 月至 2019 年 12 月期间实施的所有 STA-MCA 搭桥术。纳入获得术前和随访导管血管造影的患者。临床结果包括症状改善和复发性脑血管事件。研究人员进行了逻辑回归、Cox回归和Kaplan-Meier分析,以探讨PCF与临床结局之间的关联:在154名患者的165个有症状半球中,分别有104个(63.0%)和61个(37.0%)半球的PCF良好和不良。PCF良好的半球更年轻(p = 0.004),入院时血流动力学功能障碍的发生率更高(p p = 0.014),这与复发性脑血管事件的发生率较高有关。在出血性发病的半球中,PCF良好组症状改善的发生率更高(P P = 0.031)。在缺血发作的半球中,PCF良好组症状改善的发生率也更高(P = 0.028):作为血管造影结果,侧支形成是衡量成人多发性硬化症患者 STA-MCA 搭桥术后临床结果的合格替代指标。
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Association between angiographic and clinical outcomes after STA-MCA bypass in adult moyamoya disease.

Background and purpose: As an angiographic outcome, postoperative collateral formation (PCF) is commonly used to evaluate the effect of STA-MCA bypass in moyamoya disease (MMD), but whether it can reliably reflect clinical outcomes is still unclear. We investigated the association between PCF and clinical outcomes in adult MMD.

Methods: All STA-MCA bypass procedures performed from January 2013 to December 2019 were screened in this prospective cohort study. Patients who acquired presurgical and follow-up catheter angiography were included. The clinical outcomes consisted of symptom improvement and recurrent cerebrovascular events. Logistic and Cox regression and Kaplan-Meier analyses were performed to explore the association between PCF and clinical outcomes.

Results: Of 165 included symptomatic hemispheres of 154 patients, 104 (63.0%) and 61 (37.0%) had good and poor PCF, respectively. The hemispheres with good PCF were younger (p = 0.004) and had a higher incidence of hemodynamic dysfunction on admission (p < 0.001) than those with poor PCF. Multivariate logistic regression analysis showed that the good PCF (odd ratio, 28.96; 95% confidence interval (CI), 9.12-91.98; p < 0.001) was associated with a higher incidence of symptom improvement. Multivariate Cox regression analysis showed that the poor PCF (hazard ratio, 3.77; 95% CI, 1.31-10.84; p = 0.014) was associated with a higher incidence of recurrent cerebrovascular events. In the hemorrhagic-onset hemispheres, good PCF group had a higher incidence of symptom improvement (p < 0.001) and a longer hemorrhage-free time (p = 0.031). In the ischemic-onset hemispheres, good PCF group also had a higher incidence of symptom improvement (p < 0.001) and a longer ischemia-free time (p = 0.028).

Conclusions: As a angiographic outcome, collateral formation is a qualified surrogate measure for clinical outcomes after STA-MCA bypass in adult MMD.

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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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