Cerebrovascular events after surgery versus conservative therapy for moyamoya disease: a meta-analysis

被引:0
作者
Anke Wouters
Ide Smets
Wim Van den Noortgate
Gary K. Steinberg
Robin Lemmens
机构
[1] KU Leuven,Department of Neurosciences, Experimental Neurology
[2] University of Leuven,Department of Neurology
[3] VIB Center for Brain & Disease Research,Laboratory for Neuroimmunology, Department of Neurology
[4] University Hospitals Leuven,Faculty of Psychology and Educational Sciences
[5] University Hospitals Leuven,IMEC
[6] KU Leuven,ITEC
[7] University of Leuven,Department of Neurosurgery and Stanford Stroke Center
[8] KU Leuven,undefined
[9] University of Leuven,undefined
[10] Stanford University School of Medicine,undefined
来源
Acta Neurologica Belgica | 2019年 / 119卷
关键词
Moyamoya disease; Moyamoya; Meta-analysis; Outcome; Surgical intervention; Treatment;
D O I
暂无
中图分类号
学科分类号
摘要
The background of this article is to determine the effect of a neurosurgical intervention in patients with moyamoya disease (MMD) on the risk of cerebrovascular events. We included studies with at least ten MMD patients in either intervention or control group which investigated cerebrovascular events during a minimal follow-up period of 1 year after neurosurgical intervention vs. conservative therapy. The primary outcome was all strokes; secondary outcome events were mortality, hemorrhagic, and ischemic stroke. Effects were evaluated for three prespecified subpopulations: adult, ischemic, and hemorrhagic moyamoya patients. We performed random-effects meta-analyses on odds ratios (ORs). We included 2,484 patients from 10 studies. The rate of all stroke was 14.1% in surgical treated compared to 30.0% in non-surgical-treated patients [pooled OR 0.38, 95%; confidence interval (CI) 0.23–0.64]. In subgroup analyses, we identified an association between surgery and all stroke in patients presenting with hemorrhagic, but not in patients with ischemic MMD. Hemorrhagic stroke during follow-up was less frequent in patients who underwent a surgical intervention, 4.6% compared to 18.6% of the conservatively treated patients (pooled OR 0.27, 95% CI 0.14–0.53). In addition, we observed a difference in mortality, 0.6% vs. 2.9% (pooled OR 0.32, 95% CI 0.13–0.77), but did not identify an association between surgical treatment and ischemic stroke (pooled OR 0.71, 95% CI 0.46–1.09). Surgical intervention in MMD is associated with a decreased risk of stroke most striking in patients presenting with hemorrhagic MMD. The relationship was present between surgical treatment and the outcome of hemorrhagic, but not ischemic stroke.
引用
收藏
页码:305 / 313
页数:8
相关论文
共 70 条
  • [1] Kuroda S(2008)Moyamoya disease : current concepts and future perspectives Lancet Neurol 7 1056-1066
  • [2] Houkin K(2010)Cerebrovascular disease: new data on surgical therapy for pediatric moyamoya disease Nat Rev Neurol 6 242-243
  • [3] Kuroda S(2016)Long-term follow-up of pediatric moyamoya disease treated by combined direct—indirect revascularization surgery : single institute experience with surgical and perioperative management Neurosurg Rev 39 615-623
  • [4] Rashad S(2010)Indirect revascularization techniques for treating moyamoya disease Neurosurg Clin NA 21 553-563
  • [5] Fujimura M(2012)Bypass surgery for moyamoya disease—concept and essence of surgical techniques Neurol Med Chir 52 287-294
  • [6] Niizuma K(2014)Less invasive pedicled omental-cranial transposition in pediatric patients with moyamoya disease and failed prior revascularization Neurosurgery 10 1-14
  • [7] Patel NN(2014)Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan adult moyamoya trial Stroke 45 1415-1421
  • [8] Mangano FT(1997)Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis (‘Moyamoya’ disease) Clin Neurol Neurosurg. 99 S238-S240
  • [9] Klimo P(1969)Cerebrovascular, “moyamoya” disease: disease showing abnormal net-like vessels in base of brain Arch Neurol 20 288-299
  • [10] Kuroda S(2010)Conducting meta-analyses in R with the metafor package J Stat Softw 36 1-48