PDF(Pubmed)
Abstract：
BACKGROUND: At present, the most effective treatment for symptomatic moyamoya disease (MMD) is surgery. However, the high incidence of postoperative complications is a serious problem plaguing the surgical treatment of MMD, especially the acute cerebral infarction. Decreased cerebrovascular reserve is an independent risk factor for ischemic infarction, and the pulsatility index (PI) of transcranial Doppler (TCD) is a common intuitive index for evaluating intracranial vascular compliance. However, the relationship between PI and the occurrence of ischemic stroke after operation is unclear.
OBJECTIVE: To explore whether the PI in the middle cerebral artery (MCA) could serve as a potential predictor for the occurrence of ischemic infarction after bypass surgery in MMD.
METHODS: We performed a retrospective analysis of data from 71 patients who underwent combined revascularization surgery, including superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-myo-synangiosis (EDMS). The patients were divided into two groups according to the median of ipsilateral MCA-PI before operation, low PI group (MCA-PI < 0.614) and high PI group (MCA-PI ≥ 0.614). Univariate and multivariate regression analysis were used to explore risk factors affecting the occurrence of postoperative cerebral infarction.
RESULTS: Among the 71 patients with moyamoya disease, 11 patients had cerebral infarction within one week after revascularization. Among them, 10 patients\' ipsilateral MCA-PI were less than 0.614, and another one\'s MCA- PI is higher than 0.614. Univariate analysis showed that the lower ipsilateral MCA-PI (0.448 ± 0.109 vs. 0.637 ± 0.124; P = 0.001) and higher Suzuki stage (P = 0.025) were linked to postoperative cerebral infarction. Multivariate analysis revealed that lower ipsilateral MCA-PI was an independent risk factor for predicting postoperative cerebral infarction (adjusted OR = 14.063; 95% CI = 6.265 ~ 37.308; P = 0.009).
CONCLUSIONS: A lower PI in the ipsilateral MCA may predict the cerebral infarction after combined revascularization surgery with high specificity. And combined revascularization appears to be safer for the moyamoya patients in early stages.
OBJECTIVE: To explore whether the PI in the middle cerebral artery (MCA) could serve as a potential predictor for the occurrence of ischemic infarction after bypass surgery in MMD.
METHODS: We performed a retrospective analysis of data from 71 patients who underwent combined revascularization surgery, including superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-myo-synangiosis (EDMS). The patients were divided into two groups according to the median of ipsilateral MCA-PI before operation, low PI group (MCA-PI < 0.614) and high PI group (MCA-PI ≥ 0.614). Univariate and multivariate regression analysis were used to explore risk factors affecting the occurrence of postoperative cerebral infarction.
RESULTS: Among the 71 patients with moyamoya disease, 11 patients had cerebral infarction within one week after revascularization. Among them, 10 patients\' ipsilateral MCA-PI were less than 0.614, and another one\'s MCA- PI is higher than 0.614. Univariate analysis showed that the lower ipsilateral MCA-PI (0.448 ± 0.109 vs. 0.637 ± 0.124; P = 0.001) and higher Suzuki stage (P = 0.025) were linked to postoperative cerebral infarction. Multivariate analysis revealed that lower ipsilateral MCA-PI was an independent risk factor for predicting postoperative cerebral infarction (adjusted OR = 14.063; 95% CI = 6.265 ~ 37.308; P = 0.009).
CONCLUSIONS: A lower PI in the ipsilateral MCA may predict the cerebral infarction after combined revascularization surgery with high specificity. And combined revascularization appears to be safer for the moyamoya patients in early stages.
摘要：
背景：目前，有症状的烟雾病(MMD)最有效的治疗方法是手术.然而,术后并发症的高发生率是困扰MMD手术治疗的严重问题,尤其是急性脑梗塞。脑血管储备减少是缺血性脑梗死的独立危险因素,经颅多普勒(TCD)的搏动指数(PI)是评价颅内血管顺应性的常用直观指标。然而,PI与术后缺血性卒中发生的关系尚不清楚。
目的：探讨大脑中动脉（MCA）PI是否可以作为MMD搭桥手术后缺血性脑梗死发生的潜在预测因子。
方法：我们对接受联合血运重建手术的71例患者的数据进行了回顾性分析，包括颞浅动脉-大脑中动脉（STA-MCA）吻合术和脑-硬-肌-血管综合征（EDMS）。根据术前同侧MCA-PI的中位数将患者分为两组。低PI组(MCA-PI<0.614)和高PI组(MCA-PI≥0.614)。采用单因素和多因素回归分析探讨影响术后脑梗死发生的危险因素。
结果：在71例烟雾病患者中，11例患者在血运重建后1周内出现脑梗死。其中,10例患者同侧MCA-PI小于0.614，另1例MCA-PI高于0.614。单因素分析显示同侧MCA-PI较低(0.448±0.109vs.0.637±0.124；P=0.001）和更高的Suzuki分期（P=0.025）与术后脑梗死有关。多因素分析显示，下侧MCA-PI是预测术后脑梗死的独立危险因素（校正OR=14.063；95%CI=6.265~37.308；P=0.009）。
结论：同侧MCA中PI较低可预测联合血管重建术后脑梗死的特异性。对于早期的烟雾患者，联合血运重建似乎更安全。
目的：探讨大脑中动脉（MCA）PI是否可以作为MMD搭桥手术后缺血性脑梗死发生的潜在预测因子。
方法：我们对接受联合血运重建手术的71例患者的数据进行了回顾性分析，包括颞浅动脉-大脑中动脉（STA-MCA）吻合术和脑-硬-肌-血管综合征（EDMS）。根据术前同侧MCA-PI的中位数将患者分为两组。低PI组(MCA-PI<0.614)和高PI组(MCA-PI≥0.614)。采用单因素和多因素回归分析探讨影响术后脑梗死发生的危险因素。
结果：在71例烟雾病患者中，11例患者在血运重建后1周内出现脑梗死。其中,10例患者同侧MCA-PI小于0.614，另1例MCA-PI高于0.614。单因素分析显示同侧MCA-PI较低(0.448±0.109vs.0.637±0.124；P=0.001）和更高的Suzuki分期（P=0.025）与术后脑梗死有关。多因素分析显示，下侧MCA-PI是预测术后脑梗死的独立危险因素（校正OR=14.063；95%CI=6.265~37.308；P=0.009）。
结论：同侧MCA中PI较低可预测联合血管重建术后脑梗死的特异性。对于早期的烟雾患者，联合血运重建似乎更安全。
