Abstract
Aim: The purpose of this study was to compare the 5-year prognosis of combined superficial
temporal artery- middle cerebral artery (STA-MCA) bypass and Encephalodurosynangiosis
(EDAS) and EDAS alone in hemorrhagic moyamoya disease (MMD). Methods: This study included 123 adult patients admitted to Beijing Tiantan Hospital with
hemorrhagic MMD between 2010 and 2015. The surgical procedures included combined revascularization
of STA-MCA anastomosis with EDAS (n = 79) or EDAS alone (n = 44). We recorded basic
demographic data as well as several risks factors, and used multivariate regression
analysis to evaluate the predictive factor of overall survival and rebleeding-free
survival. Results: Of the 123 patients with hemorrhagic MMD, the mean age was 37.97 ± 11.04 years old
and the mean follow-up period was 65.9 months (ranging from 12 to 100 months). A total
of 21 rebleeding events occurred in 19 patients, yielding an annual incidence of rebleeding
of 3.1%. Of the 19 patients with rebleeding, 11 (57.8%) patients died of rebleeding
and one patient experience 3 rebleeding events. In the combined revascularization
group, 9 (11.3%) patients experienced rebleeding, of which 5 (6.3%) died. This incidence
was lower than in the indirect group, where 22.7% of patients experienced rebleeding
events and 13.6% died. However, no significant difference was found between these
2 groups. In Kaplan-Meier survival analysis, the combined revascularization group
had a better prognosis than the EDAS alone group, and multivariate regression analysis
revealed that the combined revascularization procedure was associated with a better
outcome. Conclusions: Both combined revascularization and EDAS alone can reduce the risk of rebleeding
in hemorrhagic MMD. Combined revascularization was found to be superior to EDAS alone
in terms of preventing rebleeding events.
Key Words
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Article info
Publication history
Published online: April 18, 2020
Accepted:
March 11,
2020
Received in revised form:
February 15,
2020
Received:
December 26,
2019
Footnotes
Funding: This study was supported by National Natural Science Foundation of China (81701137), Key Technology Research and Development Program of the Ministry of Science and Technology of China (2015BAI12B04), Beijing Municipal Organization Department talents project (2015000021469G219), Beijing Municipal ST Commission (D161100003816005).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104811
Copyright
© 2020 Elsevier Inc. All rights reserved.
