Stroke-Related Outcomes in Moyamoya Disease Compared with Moyamoya Syndromes: A Propensity-Matched Analysis.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2025-02-01 Epub Date: 2024-12-19 DOI:10.1016/j.wneu.2024.11.104

Aryan Wadhwa, Kimberly Han, Felipe Ramirez-Velandia, Omar Alwakaa, Coleman Riordan, Evan McNeil, Justin H Granstein, Philipp Taussky, Alejandro Enriquez-Marulanda, Christopher S Ogilvy

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引用次数: 0

Abstract

Objective: Moyamoya syndrome (MMS) is a subset of moyamoya disease (MMD) with a systemic comorbidity. Due to the lack of direct comparisons between various MMS subgroups and their MMD counterparts, we aimed to analyze differences in stroke-related outcomes between MMS subgroups and patients with MMD through propensity score matching (PSM).

Methods: We analyzed the National Inpatient Sample (NIS) from 2011 to 2020 for patients with MMD and common MMS-related comorbidities: Down syndrome (DS), sickle-cell disease (SCD), and type 1 neurofibromatosis (NF1). PSM was performed to match patients of each MMS subgroup to patients with MMD only, controlling for stroke risk factors. Rates of ischemic strokes, hemorrhagic strokes, and transient ischemic attacks (TIAs) were evaluated after matching.

Results: A total of 10,652 patients with a moyamoya diagnosis were identified: 7971 with MMD only, 2202 with MMS-SCD, 162 with MMS-NF1, and 317 with MMS-DS. PSM for MMD only and MMS-SCD resulted in 630 matched pairs. After matching, univariate analysis showed that patients with MMS-SCD had significantly lower rates of ischemic strokes (8.9% vs. 17.9%; P = 0.001), hemorrhagic strokes (5.1% vs. 8.1%; P = 0.031), and TIAs (2.2% vs. 4.6%; P = 0.020) than did patients with MMD only. For the MMS-DS subgroup, 92 matched pairs showed significantly lower rates of TIAs than did patients with MMD only (0% vs. 6.5%; P = 0.013). Comparing 54 matched pairs of patients with MMD only and patients with MMS-NF1 showed no significant differences in stroke-related outcomes.

Conclusions: Patients with MMS-SCD had significantly lower rates of acute ischemic stroke, hemorrhagic stroke, and TIA compared with patients with MMD only. Future research should consider the source of these differences in improving stroke prevention in patients with MMD.

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烟雾病与烟雾综合征的卒中相关结局：倾向匹配分析

目的：烟雾综合征（MMS）是烟雾病（MMD）的一个亚群，具有全身性合并症。由于缺乏各种MMS亚组与烟雾病患者之间的直接比较，我们旨在通过倾向评分匹配（PSM）分析MMS亚组与烟雾病患者之间卒中相关结局的差异。方法：我们分析了2011-2020年全国住院患者样本（NIS）中烟雾病患者，以及常见的与烟雾相关的合并症：唐氏综合征（DS）、镰状细胞病（SCD）和1型神经纤维瘤病（NF1）。采用PSM将每个MMS亚组的患者与仅患有mmd的患者进行匹配，控制卒中危险因素。匹配后评估缺血性卒中、出血性卒中和短暂性脑缺血发作（TIA）的发生率。结果：共有10652例烟雾病患者被确诊：7971例仅为mmd， 2202例为MMS-SCD， 162例为MMS-NF1, 317例为MMS-DS。仅mmd和MMS-SCD的PSM配对结果为630对。匹配后，单因素分析显示MMS-SCD患者缺血性卒中发生率显著降低(8.9% vs 17.9%；P =0.001)，出血性中风(5.1% vs 8.1%；p=0.031)和TIAs (2.2% vs 4.6%；p=0.020)。对于MMS-DS亚组，92对配对组的tia发生率明显低于单纯mmd患者(0% vs 6.5%；p = 0.013)。比较54对匹配的MMD-only和MMS-NF1患者，卒中相关结局无显著差异。结论：与纯烟雾病患者相比，MMS-SCD患者的急性缺血性卒中、出血性卒中和TIA发生率显著降低。未来的研究应考虑这些差异的来源，以改善烟雾病患者的卒中预防。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS