Abstract：
Indirect bypass surgery is an effective treatment for moyamoya disease (MMD), but the success of the surgery depends on the formation of spontaneous collateral vessels, which cannot be accurately predicted before surgery. Developing a prediction nomogram model for neoangiogenesis in patients after indirect revascularization surgery can aid surgeons in identifying suitable candidates for indirect revascularization surgery. This retrospective observational study enrolled patients with MMD who underwent indirect bypass surgery from a multicenter cohort between December 2010 and December 2018. Data including potential clinical and radiological predictors were obtained from hospital records. A nomogram was generated based on a multivariate logistic regression analysis identifying potential predictors of good neoangiogenesis. A total of 263 hemispheres of 241 patients (mean ± SD age 24.38 ± 15.78 years, range 1-61 years) were reviewed, including 168 (63.9%) hemispheres with good postoperative collateral formation and 95 (36.1%) with poor postoperative collateral formation. Based on multivariate analysis, a nomogram was formulated incorporating four predictors, including age at operation, abundance of ICA moyamoya vessels, onset type, and Suzuki stage. The C-index for this nomogram was 0.80. Calibration curve and decision-making analysis validated the fitness and clinical application value of this nomogram. The nomogram developed in this study exhibits high accuracy in predicting good neoangiogenesis after indirect revascularization surgery in MMD patients. This model can be very helpful for clinicians when making decisions about surgical strategies for MMD patients in clinical practice.
摘要：
间接搭桥手术是烟雾病（MMD）的有效治疗方法，但是手术的成功取决于自发侧支血管的形成，手术前无法准确预测。建立间接血运重建手术后患者新血管生成的预测列线图模型可以帮助外科医生确定间接血运重建手术的合适候选者。这项回顾性观察性研究从2010年12月至2018年12月的多中心队列中纳入了接受间接搭桥手术的MMD患者。从医院记录中获得包括潜在临床和放射学预测因子的数据。基于多变量逻辑回归分析生成列线图,确定良好新血管生成的潜在预测因子。241例患者共263个半球（平均年龄24.38±15.78岁，范围1-61年)进行了审查，包括168个（63.9％）术后侧支形成良好的半球和95个（36.1％）术后侧支形成不良的半球。基于多变量分析，列线图包含四个预测因子，包括手术年龄，丰富的ICA烟雾血管，发病类型,铃木舞台。该列线图的C指数为0.80。校准曲线和决策分析验证了该列线图的适用性和临床应用价值。这项研究中开发的列线图在预测MMD患者间接血运重建手术后良好的新血管生成方面具有很高的准确性。该模型对临床医生在临床实践中对MMD患者的手术策略做出决定时非常有帮助。
