European Stroke Organisation (ESO) Guidelines on Moyamoya angiopathy: Endorsed by Vascular European Reference Network (VASCERN)

被引:37
作者
Bersano, Anna [1 ]
Khan, Nadia [2 ,3 ]
Fuentes, Blanca [4 ,5 ]
Acerbi, Francesco [1 ]
Canavero, Isabella [1 ]
Tournier-Lasserve, Elisabeth [6 ]
Vajcoczy, Peter [7 ]
Zedde, Maria Luisa [8 ]
Hussain, Salman [9 ]
Lemeret, Sabrina [9 ]
Kraemer, Markus [10 ,11 ]
Herve, Dominique [12 ]
机构
[1] Fdn IRCCS Ist Neurol Carlo Besta, Cerebrovasc Unit, Milan, Italy
[2] Univ Childrens Hosp Zurich, Moyamoya Ctr, Zurich, Switzerland
[3] Univ Tubingen, Moyamoya Ctr adults, Dept Neurosurg, Tubingen, Germany
[4] Univ Autonoma Madrid, La Paz Univ Hosp, Hosp La Paz Inst Hlth Res IdiPAZ, Dept Neurol, Madrid, Spain
[5] Univ Autonoma Madrid, La Paz Univ Hosp, Hosp Paz Inst Hlth Res IdiPAZ, Stroke Ctr, Madrid, Spain
[6] Hosp Robert Debre, INSERM U1141, Paris, France
[7] Charite Univ Med Berlin, Dept Neurosurg, Berlin, Germany
[8] Azienda Unita Sanitaria Locale IRCCS Reggio Emilia, Neurol Unit, Stroke Unit, Reggio Emilia, Italy
[9] European Stroke Org, Basel, Switzerland
[10] Alfried Krupp Hosp, Dept Neurol, APHP Nord, Essen, Germany
[11] Heinrich Heine Univ, Med Fac, Dept Neurol, Dusseldorf, Germany
[12] Hop Lariboisiere, Natl Referral Ctr Rare Vasc Dis Brain & Eye CERVCO, 2 Rue Ambroise Pare, F-75010 Paris, France
关键词
Moyamoya angiopathy; diagnosis; therapy; stroke; guidelines; systematic review; LONG-TERM OUTCOMES; SINGLE-CENTER EXPERIENCE; ADULT MOYAMOYA; CLINICAL-FEATURES; INDIRECT REVASCULARIZATION; POSTERIOR CIRCULATION; SURGICAL-TREATMENT; SPONTANEOUS OCCLUSION; ANTIPLATELET THERAPY; HEMODYNAMIC STRESS;
D O I
10.1177/23969873221144089
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:55 / 84
页数:30
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