Analysis Of Characteristics And Related Factors Of Hemorrhagic Stroke After Ischemic Moyamoya Disease

Research Objective: Moyamoya disease(MMD)is a common cerebral vascular disease in neurosurgery.Moyamoya disease is differentiated according to different clinical symptoms and can be divided into ischemic and hemorrhagic moyamoya disease.Ischemia-type moyamoya disease is clinically more common.see.In the current study,there are relatively few reports of intracranial hemorrhagic strokes after intracranial and extracranial revascularization in patients with ischaemic moyamoya disease.To retrospectively analyze the possible causes of hemorrhagic stroke after mobill bypass surgery.The data of 157 patients with ischemic moyamoya disease treated by surgery in our hospital were collected.To analyze and discuss the risk factors and clinical features of post-operative intracerebral hemorrhagic stroke,and to provide reference for the prevention of hemorrhagic stroke in postoperative patients with ischemic moyamoya disease.Objects and Methods:To collect detailed clinical data of patients with ischemic moyamoya disease treated surgically from January 2010 to January 2017 in Department of Neurosurgery,First Affiliated Hospital of Zhengzhou University.Retrospective of analysis was used to perform a retrospective follow-up study of patients.Follow-up patients' postoperative follow-up examination results were used to determine whether postoperative intracerebral hemorrhagic stroke occurred.If a stroke occurred,the characteristics of stroke were recorded in detail and excluded.A total of 157 patients who met the standard were collected for deaths and lost follow-up cases.According to the patient's clinical data,the analysis of the factors that may affect postoperative cerebral hemorrhagic stroke events may be considered as a possible risk factor for postoperative hemorrhagic stroke.Firstly,the univariate analysis of all possible risk factors leading to post-operative hemorrhagic stroke was performed using the chi-square test.Based on the results obtained,statistically significant factors were selected.Then using multivariate multivariate logistic regression analysis for multivariate analysis of the results of the relevant factors,both of which were set to p < 0.05 considered statistically significant,resulting in ischaemic moyamoya disease after intracranial and extracranial revascularization surgery Risk factors associated with hemorrhagic stroke.Results: A total of 19 patients with postoperative hemorrhagic stroke during the follow-up period were collected from 157 patients with ischemic moyamoya disease.The causes of bleeding included intracerebral hemorrhage in 10 cases,epidural hemorrhage in 4 cases,and subdural hemorrhage in 3 cases.Two cases were diagnosed with intracranial aneurysms before surgery and the subarachnoid space was caused by ruptured aneurysm after surgery.Bleeding.The univariate chi-square test showed preoperative hypertension(P=0.006),postoperative antiplatelet aggregation(P=0.002),and surgical approach(P=0.028).The occurrence of hemorrhagic stroke is related.Multivariate Logistic regression analysis showed that patients with hypertension(OR=4.053),postoperative antiplatelet aggregation(OR=6.578)and different surgical approaches(OR=0.267)caused ischemic moyamoya disease intracranial and extracranial Independent risk factors for hemorrhagic stroke after revascularization.Conclusions:1.For patients with ischaemic moyamoya disease,if preoperative patients have hypertension,postoperative care should be taken to maintain stable blood pressure and avoid severe fluctuations in blood pressure.2.Intracranial combined with vascular bypass surgery as an effective surgical method for the treatment of ischemic MMD can improve cerebral blood perfusion in the ischemic region and improve cerebral ischemic symptoms,but the risk of postoperative intracranial hemorrhagic stroke Higher than indirect revascularization surgery.3.Long-term administration of antiplatelet aggregation drugs after ischemic moyamoya disease can easily lead to intracerebral hemorrhagic stroke events.Therefore,patients with postoperative moyamoya disease should be cautious about long-term use of antiplatelet aggregation drugs,and should be carried out regularly for patients taking them.Related tests to guide the application of clinical drugs.