PDF(Pubmed)
Abstract：
The necessity of bilateral bypass in adult moyamoya disease (MMD) remains unclear despite its recommendation for pediatric and hemorrhagic cases. We aimed to investigate the natural course of hemodynamically stable unoperated hemispheres after bypass surgery for symptomatic and hemodynamically unstable hemispheres in adult patients with ischemic MMD. Among 288 patients, the mean age at the first operation of the unstable hemispheres was 40.8 ± 12.2 years. The mean follow-up period was 62.9 ± 46.5 months. 45 patients (15.6%) experienced stroke events in the unoperated hemisphere, consisting of hemorrhagic stroke in 8 (2.8%) and ischemic stroke in 37 (12.8%), including progressive transient ischemic attack in 25 (8.7%) and infarction in 12 (4.2%). Among them, 39 patients (13.5%) underwent bypass surgery. The annual risk of total stroke is 3.0%/patient-year, with 2.5% for ischemic stroke and 0.5% for hemorrhagic stroke. The 5- and 10-year cumulative risks of ischemic stroke were 13.4% and 18.3%, respectively, and those of hemorrhagic stroke were each 3.2%. The natural course of hemodynamically stable hemispheres contralateral to the operated ones appeared fairly good. Additional bypass surgery on the unoperated hemispheres should be considered for symptomatic and hemodynamically unstable hemispheres in adult patients with ischemic MMD during the follow-up.
摘要：
尽管成人烟雾病（MMD）建议使用小儿和出血性病例，但仍不清楚双侧旁路的必要性。我们旨在研究成年缺血性MMD患者的有症状和血液动力学不稳定半球的搭桥手术后血液动力学稳定的未手术半球的自然过程。在288名患者中，不稳定半球首次手术的平均年龄为40.8±12.2岁。平均随访时间为62.9±46.5个月。45例患者（15.6%）在未手术的半球出现卒中事件，包括8例出血性中风（2.8％）和37例缺血性中风（12.8％），包括25例（8.7％）的进行性短暂性脑缺血发作和12例（4.2％）的梗塞。其中,39例(13.5%)患者行搭桥手术。总中风的年风险为3.0%/患者年，缺血性中风为2.5%，出血性中风为0.5%。缺血性卒中的5年和10年累积风险分别为13.4%和18.3%,分别,出血性卒中分别为3.2%。与手术对侧的血液动力学稳定半球的自然过程似乎相当好。对于成年缺血性MMD患者，在随访期间有症状和血流动力学不稳定的半球，应考虑对未手术的半球进行额外的旁路手术。
