Effects of antiplatelet therapy on reducing stroke risk in patients with moyamoya disease: the role of postcontrast MR vessel wall imaging.

IF 4.7 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Radiology Pub Date : 2025-10-01 Epub Date: 2025-04-11 DOI:10.1007/s00330-025-11562-9

Mingming Lu, Hongtao Zhang, Shitong Liu, Yuan Liu, Baobao Li, Fangbin Hao, Peng Peng, Fugeng Sheng, Xihai Zhao, Fei Yuan, Cong Han, Jianming Cai

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引用次数: 0

Abstract

Objective: To evaluate the role of vessel wall enhancement in the efficacy of antiplatelet therapy (APT) on reducing the stroke risk in patients with Moyamoya disease (MMD) based on postcontrast MR vessel wall imaging.

Methods: Consecutive patients with MMD underwent postcontrast MR vessel wall imaging and were divided into APT and non-APT groups according to the prescribed antiplatelet agents. Kaplan-Meier survival and Cox regression analyses were performed to determine the association between APT and stroke risk of patients with MMD, and subgroup analysis was performed to determine the role of vessel wall enhancement in reducing stroke risk after APT.

Results: A total of 1262 patients (mean age: 42.6 ± 11.1 years) were finally included for analysis. Compared with patients without APT, those with APT were older (p = 0.023) and had a higher incidence of hypertension (p = 0.015), and with advanced Suzuki stage (≥ IV) (p < 0.001). During an average follow-up of 37.9 months, patients without APT had a marginally greater incidence of cerebrovascular events (12.9% vs. 9.7%; HR p = 0.069) than those who underwent APT before and after propensity score matching. The subgroup analyses revealed that vessel wall enhancement had a significant interaction effect on the association between APT and stroke outcomes, and APT could significantly reduce stroke risk in MMD patients with vessel wall enhancement (HR = 0.43; 95% CI: 0.23-0.79, interaction p = 0.038).

Conclusion: APT may significantly reduce stroke risk in patients with MMD with vessel wall enhancement.

Key points: Question The effect of antiplatelet therapy (APT) varies in patients with moyamoya disease (MMD). Findings APT may significantly reduce stroke risk for MMD patients with vessel wall enhancement. Clinical relevance Post-contrast high-resolution MRI may help identify MMD patients who would mostly benefit from APT; APT should be highly recommended in MMD patients with vessel wall enhancement.

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抗血小板治疗对降低烟雾病患者卒中风险的影响：磁共振血管壁成像的作用

目的：基于磁共振血管壁成像，评价血管壁增强在抗血小板治疗（APT）降低烟雾病（MMD）患者卒中风险中的作用。方法：连续的烟雾病患者行MR血管壁造影，根据处方抗血小板药物分为APT组和非APT组。通过Kaplan-Meier生存和Cox回归分析来确定APT与烟雾病患者卒中风险的相关性，并进行亚组分析来确定血管壁增强在降低APT后卒中风险中的作用。结果：最终纳入1262例患者（平均年龄：42.6±11.1岁）进行分析。与非APT患者相比，APT患者年龄较大（p = 0.023），高血压发病率较高（p = 0.015），且铃木期（≥IV期）晚期(p) (p结论：APT可显著降低伴有血管壁增强的烟雾病患者卒中风险。抗血小板治疗（APT）在烟雾病（MMD）患者中的效果各不相同。发现APT可显著降低血管壁增强的烟雾病患者脑卒中风险。对比后的高分辨率MRI可能有助于识别烟雾病患者，谁将最受益于APT；强烈建议有血管壁增强的烟雾病患者使用APT。

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

European Radiology 医学-核医学

CiteScore

11.60

自引率

8.50%

发文量

874

审稿时长

2-4 weeks

期刊介绍： European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.