目的:烟雾病(MMD)患者可出现缺血性或出血性卒中。在MMD相关急性缺血性卒中(AIS)的治疗策略中没有很好的证据,特别是用于静脉溶栓(IVT)和血管内血栓切除术(ET)等治疗。由于MMD的颅内血管易碎,出血的风险很高,IVT和ET的使用存在争议。阐明IVT/ET治疗MMD相关性AIS的安全性和有效性,我们进行了系统回顾和荟萃总结来研究这一问题.
方法:从四个电子数据库中进行了系统搜索:PubMed(MEDLINE),科克伦图书馆,EMBASE和Scopus,从成立到2021年11月21日的剖析数据,以及,在GoogleScholar上手动操作。
结果:10例报告详述了10例MMD患者出现AIS并接受IVT或ET,或者两者兼而有之,包括在分析中。美国国立卫生研究院卒中量表评分中位数为10分(四分位范围[IQR]=6.0-16.5)。仅在6例患者中进行了IVT,2例尝试初次ET,2例接受了ET桥接IVT。在接受ET的4名患者中,2例患者成功再灌注(改良脑梗死溶栓评分[mTICI]≥2b)。就功能结果而言,1例患者完全恢复(改良Rankin量表0),4名患者的神经系统状况得到改善,4没有任何改善,而1例患者的功能结局未报告。没有患者出现症状性颅内出血。
结论:在这篇系统综述和荟萃总结中,在选定的病例中,IVT和ET在MMD相关AIS中的应用似乎是可行的。需要进一步的更大的队列研究来评估这些治疗方法。
结论:·MMD中的AIS通常通过旁路手术治疗,但不通过溶栓或血栓切除术治疗。·在这个元总结中,所有接受溶栓和/或取栓治疗的患者均存活,部分患者出现症状和/或功能改善.·进一步更大的队列研究对于研究溶栓和/或血栓切除术作为MMD中AIS治疗的作用是必要的。
OBJECTIVE: Patients with Moyamoya disease (MMD) can present with ischaemic or haemorrhagic stroke. There is no good evidence for treatment strategies in MMD-associated acute ischaemic stroke (AIS), particularly for treatments like intravenous thrombolysis (IVT) and endovascular thrombectomy (ET). As the intracranial vessels are friable in MMD, and the risk of bleeding is high, the use of IVT and ET is controversial. To clarify the safety and efficacy of IVT/ET in the treatment of MMD-associated AIS, we performed a systematic review and meta-summary to examine this issue.
METHODS: A systematic search was performed from four electronic databases: PubMed (MEDLINE), Cochrane Library, EMBASE and Scopus, profiling data from inception till 21 November 2021, as well as, manually on Google Scholar.
RESULTS: Ten
case reports detailing 10 MMD patients presenting with AIS and undergoing IVT or ET, or both, were included in the analysis. The median National Institute of Health Stroke Scale score at presentation was 10 (Interquartile Range [IQR] = 6.0-16.5). IVT alone was instituted in 6 patients, primary ET was attempted in 2, and 2 had received bridging IVT with ET. Of the 4 patients who underwent ET, 2 patients achieved successful reperfusion (modified Thrombolysis In Cerebral Infarction scale [mTICI] ≥ 2b). In terms of functional outcomes, One patient achieved complete recovery (modified Rankin Scale 0), 4 patients attained improvement in neurological status, and 4 had no improvement, whilst functional outcome was unreported in 1 patient. No patient experienced symptomatic intracranial haemorrhage.
CONCLUSIONS: In this systematic review and meta-summary, the utility of IVT and ET in MMD-associated AIS appears feasible in selected cases. Further larger cohort studies are required to evaluate these treatment approaches.
CONCLUSIONS: · AIS in MMD was typically managed with bypass surgery but not via thrombolysis or thrombectomy. · In this meta-summary, all patients treated with thrombolysis and/or thrombectomy survived and some experienced symptomatic and/or functional improvement. · Further larger cohort studies are necessary for investigating the role of thrombolysis and/or thrombectomy as treatment of AIS in MMD.