西洛他唑联合阿司匹林治疗小儿烟雾症：一个病例系列。

IF 2.1 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology Pub Date : 2025-09-10 DOI:10.1016/j.pediatrneurol.2025.08.023

Adeline L. Fecker BS , Matthew K. McIntyre MD , Julia E. Babcock BS , Jenny L. Wilson MD , Gary Nesbit MD , Anthony C. Wang MD , Kelly Louise Collins MD

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引用次数: 0

摘要

背景：西洛他唑是一种磷酸二酯酶III抑制剂，可引起轻度血小板聚集抑制和血管舒张。观察性研究已证实对成人烟雾动脉病（MMA）有益。西洛他唑在小儿MMA患者中的安全性、耐受性和有效性尚未报道，其中阿司匹林是最常用的抗血小板药物。方法：我们回顾了两家机构接受西洛他唑和小剂量阿司匹林治疗MMA或狭窄闭塞性疾病的儿科患者。评估术中并发症、术后出血和脑卒中。结果：我们确定了13例年龄在6个月至21岁之间的患者，10例（77%）在血运重建术前开始使用西洛他唑，3例（23%）在手术后开始使用西洛他唑。没有患者在开始西洛他唑后出现缺血性症状的增加。1例患者术中自发性脑实质出血，1例患者术后发生脑卒中。长达1年的西洛他唑随访，8例（61%）患者报告没有短暂性脑缺血发作或中风。在本报告中，西洛他唑用于接受直接或间接血运重建手术的小儿MMA患者，我们观察到出血和其他不良事件的发生率较低。没有发现西洛他唑的偷窃现象。结论：这些数据表明，说明书外用药西洛他唑可以安全地用于MMA儿童。需要更大规模的研究来评估西洛他唑治疗小儿MMA/狭窄闭塞性疾病的安全性和有效性。

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Combination of Perioperative Cilostazol and Aspirin in Pediatric Moyamoya: A Case Series

Background

Cilostazol is a phosphodiesterase III inhibitor that causes mild platelet aggregation inhibition and vasodilation. Observational studies have demonstrated benefit in adult moyamoya arteriopathy (MMA). Safety, tolerability, and efficacy of cilostazol has not been reported in pediatric MMA patients, where aspirin has been the most frequently used antiplatelet agent.

Methods

We reviewed pediatric patients at two institutions who received cilostazol and low-dose aspirin for MMA or steno-occlusive disease. Intraoperative complications, postoperative bleeding, and strokes were evaluated.

Results

We identified 13 patients between ages 6 months to 21 years, ten (77%) who started cilostazol before revascularization surgery and three (23%) who started cilostazol after surgery. No patient had an increase in ischemic symptoms after initiation of cilostazol. One patient had a spontaneous parenchymal hemorrhage intraoperatively, and one patient had postoperative strokes. Up to 1 year follow-up on cilostazol, 8 (61%) patients reported no transient ischemic attacks or strokes. In this report of cilostazol use in pediatric patients with MMA undergoing direct or indirect revascularization surgery, we observed a low rate of bleeding and other adverse events. No instances of steal phenomena from cilostazol were identified.

Conclusion

These data suggest that off-label cilostazol may be safely used in children with MMA. Larger studies are warranted to evaluate the safety and efficacy of cilostazol in pediatric MMA/steno-occlusive disease.

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.