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Войти в исследования Outcomes of bypass surgery in asymptomatic moyamoya angiopathy: A multicenter study with propensity-score weighting.
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Musmar Basel, Abdalrazeq Hammam, Roy Joanna M, Adeeb Nimer, Atallah Elias, El Naamani Kareem, Chen Ching-Jen, Jabre Roland, Saad Hassan, Grossberg Jonathan A, Dmytriw Adam A, Patel Aman B, Khorasanizadeh Mirhojjat, Ogilvy Christopher S, Monteiro Andre, Siddiqui Adnan, Cortez Gustavo M, Hanel Ricardo A, Spiotta Alejandro M, Piscopo Anthony J, Hasan David M, Ghorbani Mohammad, Weinberg Joshua, Nimjee Shahid M, Salem Mohamed M, Burkhardt Jan-Karl, Zetchi Akli, Matouk Charles, Howard Brian M, Lai Rosalind, Du Rose, Abbas Rawad, Amllay Abdelaziz, Munoz Alfredo, Herial Nabeel A, Tjoumakaris Stavropoula I, Gooch Michael Reid, Notarianni Christina, Guthikonda Bharat, Rosenwasser Robert H, Jabbour Pascal
Аннотация
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.