欧洲中风组织(ESO)关于烟雾病(MMA)的指南,根据ESO标准操作程序和建议分级开发,评估,开发和评估(等级)方法,编制的目的是帮助临床医生管理MMA患者的决策。一个由神经学家组成的工作组,神经外科医生,遗传学家和方法学家确定了九个相关的临床问题,进行系统的文献综述,只要有可能,荟萃分析。对现有证据进行了质量评估,并提出了具体建议。在没有足够证据提供建议的情况下,制定了专家共识声明。基于一份RCT的低质量证据,我们建议对有出血表现的成年患者进行直接搭桥手术.对于缺血性成人患者和儿童,我们建议使用直接或联合技术而不是间接的血运重建手术,在存在血流动力学障碍的情况下,最后一次脑血管事件和手术之间的间隔为6-12周。在没有有力审判的情况下,达成专家共识,推荐非出血性MMA的长期抗血小板治疗,因为它可以降低栓塞性中风的风险。我们还同意进行术前和术后血流动力学和大脑后动脉评估的实用性。没有足够的数据推荐RNF213p.R4810K的系统变异筛选。此外,我们建议长期MMA神经影像学随访可通过评估疾病进展来指导治疗决策.我们认为,这一指导方针,这是欧洲第一个使用GRADE方法进行MMA管理的综合指南,将帮助临床医生选择最有效的MMA管理策略。
The European Stroke Organisation (ESO)
guidelines on Moyamoya Angiopathy (MMA), developed according to ESO standard operating procedure and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, were compiled to assist clinicians in managing patients with MMA in their decision making. A working group involving neurologists, neurosurgeons, a geneticist and methodologists identified nine relevant clinical questions, performed systematic literature reviews and, whenever possible, meta-analyses. Quality assessment of the available evidence was made with specific recommendations. In the absence of sufficient evidence to provide recommendations, Expert
Consensus Statements were formulated. Based on low quality evidence from one RCT, we recommend direct bypass surgery in adult patients with haemorrhagic presentation. For ischaemic adult patients and children, we suggest revascularization surgery using direct or combined technique rather than indirect, in the presence of haemodynamic impairment and with an interval of 6-12 weeks between the last cerebrovascular event and surgery. In the absence of robust trial, an Expert
Consensus was reached recommending long-term antiplatelet therapy in non-haemorrhagic MMA, as it may reduce risk of embolic stroke. We also agreed on the utility of performing pre- and post- operative haemodynamic and posterior cerebral artery assessment. There were insufficient data to recommend systematic variant screening of RNF213 p.R4810K. Additionally, we suggest that long-term MMA neuroimaging follow up may guide therapeutic decision making by assessing the disease progression. We believe that this
guideline, which is the first comprehensive European
guideline on MMA management using GRADE methods will assist clinicians to choose the most effective management strategy for MMA.