Outcomes of bypass surgery in asymptomatic moyamoya angiopathy: A multicenter study with propensity-score weighting.

IF 4.5 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-08-30 DOI:10.1177/23969873251365504

Basel Musmar, Hammam Abdalrazeq, Joanna M Roy, Nimer Adeeb, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan A Grossberg, Adam A Dmytriw, Aman B Patel, Mirhojjat Khorasanizadeh, Christopher S Ogilvy, Ajith J Thomas, Andre Monteiro, Adnan Siddiqui, Gustavo M Cortez, Ricardo A Hanel, Guilherme Porto, Alejandro M Spiotta, Anthony J Piscopo, David M Hasan, Mohammad Ghorbani, Joshua Weinberg, Shahid M Nimjee, Kimon Bekelis, Mohamed M Salem, Jan-Karl Burkhardt, Akli Zetchi, Charles Matouk, Brian M Howard, Rosalind Lai, Rose Du, Rawad Abbas, Abdelaziz Amllay, Alfredo Munoz, Nabeel A Herial, Stavropoula I Tjoumakaris, Michael Reid Gooch, Christina Notarianni, Bharat Guthikonda, Robert H Rosenwasser, Pascal Jabbour

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引用次数: 0

Abstract

Introduction: Asymptomatic moyamoya angiopathy (MMA) is increasingly detected through noninvasive imaging; however, its optimal management remains controversial. This multicenter retrospective cohort study compared outcomes in asymptomatic versus symptomatic MMA patients undergoing surgical revascularization.

Patients and methods: A total of 475 patients treated with bypass surgery across multiple academic centers were included, with 56 (11.8%) classified as asymptomatic and 419 (88.2%) as symptomatic. Baseline demographics, surgical characteristics, and outcomes-including perioperative stroke, intraoperative complications, and follow-up stroke events-were collected. Asymptomatic MMA was defined as the absence of any prior ischemic or hemorrhagic stroke, seizures, or other neurological symptoms at the time of diagnosis. Both unadjusted analyses and propensity score weighting using inverse probability of treatment weighting (IPTW) were performed to adjust for potential confounders.

Results: In the unadjusted analysis, asymptomatic patients had significantly lower rates of all perioperative strokes (1.7% vs 11.4%; p = 0.05) and intraoperative complications (1.7% vs 11.2%; p = 0.05) compared to symptomatic patients. Additionally, follow-up stroke rates were lower in the asymptomatic group (1.7% vs 11.2%; p = 0.05). After IPTW adjustment, the reduction in intraoperative complications (OR: 0.08, 95% CI: 0.01-0.64; p = 0.01) and follow-up stroke rates (OR: 0.12, 95% CI: 0.01-0.91; p = 0.04) persisted, while differences in overall perioperative stroke were not statistically significant.

Conclusion: Bypass surgery in selected asymptomatic MMA patients is associated with reduced intraoperative complications, and fewer follow-up stroke rates. These findings support the careful consideration of surgical intervention in asymptomatic patients, emphasizing the importance of patient selection for optimal outcomes.

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无症状烟雾病患者搭桥手术的结果：一项倾向评分加权的多中心研究。

无症状烟雾血管病（MMA）越来越多地通过无创成像检测出来；然而，其最优管理仍存在争议。这项多中心回顾性队列研究比较了无症状和有症状的MMA患者接受手术血运重建术的结果。患者和方法：共有475例患者在多个学术中心接受了搭桥手术，其中56例（11.8%）被归类为无症状，419例（88.2%）被归类为有症状。收集基线人口统计学、手术特征和结果——包括围手术期卒中、术中并发症和随访卒中事件。无症状MMA定义为在诊断时没有任何先前的缺血性或出血性中风，癫痫发作或其他神经系统症状。采用未调整分析和使用治疗加权逆概率（IPTW）的倾向评分加权来调整潜在的混杂因素。结果：在未经调整的分析中，无症状患者围手术期卒中发生率（1.7% vs 11.4%, p = 0.05）和术中并发症发生率（1.7% vs 11.2%, p = 0.05）均显著低于有症状患者。此外，无症状组的随访卒中发生率较低（1.7% vs 11.2%; p = 0.05）。调整IPTW后，术中并发症（OR: 0.08, 95% CI: 0.01-0.64; p = 0.01）和随访卒中发生率（OR: 0.12, 95% CI: 0.01-0.91; p = 0.04）持续降低，而围术期卒中总体差异无统计学意义。结论：选择无症状MMA患者行搭桥手术可减少术中并发症，减少随访卒中发生率。这些发现支持对无症状患者进行手术干预的仔细考虑，强调患者选择对最佳结果的重要性。

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 Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.