The Effect Of Different Vascular Bypass In Treating Adult Moyamoya Disease:A Meta-Analysisi

Objective(s):Moyamoya disease(MMD)is a chronic occlusive cerebrovascular disease,often manifested as unilateral or bilateral internal carotid artery(ICA)siphon or middle cerebral artery(MCA)The initial segment is narrow or occluded,and an abnormal aerosolized vascular network appears at the skull base[1].The disease was first reported in 1957,and the concept of moyamoya disease was established in 1960.The common treatment methods for moyamoya disease can be divided into two ways:conservative medical treatment and surgical operation.At present,conservative medical treatment is considered to be ineffective and surgical treatment is the main method.There is currently no unified view on the standard or optimal surgical treatment of moyamoya disease.Some people believe that direct bypass surgery can directly increase cerebral perfusion,while indirect surgery requires several months to establish a good collateral circulation.This study used a meta-analysis method to compare the efficacy and safety of direct bypass surgery and indirect bypass surgery in the treatment of adult moyamoya disease.Methods:Using computer search:Embase?Cochrane?ScienceDirect?Pubmed?Medline?Ovid?Wanfang,?HowNet and other databases from January 2000 to December 2019,screening literature on the relationship between the effects and complications of direct,combined bypass and indirect bypass surgery in adults with moyamoya disease.The main observation indicators in this paper are perioperative complications;postoperative follow-up stroke events;postoperative vascular reconstruction;postoperative hemodynamic improvement.Results:A total of 675 articles were retrieved in each database,of which 12 were eligible for inclusion(1208 cases,1497 lateral hemispheres,of which DB 728 cases,IB 769 cases),and were retrospective controlled studies.Use the the Newcastle-Ottawa Scale scale(NOS)to evaluate the quality of the literature,8 of which are 6 points,3 of which are 7 points,and 1 of which are 8 points.The rusults of meta-analyses showed that:1.By the end of follow-up period,the direct bypass is better than indirect bypass in the prevention of postoperative stroke,but the difference is not statistically significant[Odds Ratio=0.66,95%Confidence Interval(0.27,1.62),P=0.37];2.The perioperative complication rate of indirect bypass for moyamoya disease is similar to that of direct bypass,and the difference is not statistically significant[Odds Ratio=1.03,95%Confidence Interval(0.72,1.48),P=0.86];3.By the end of follow-up period,the direct bypass for moyamoya disease is significantly better than indirect bypass in postoperative vascular reconstruction,and the difference is statistically significant[Odds Ratio=4.62,95%Confidence Interval(1.46,14.59),P=0.009];4,By the end of follow-up period,The improvement of hemodynamics after direct bypass for moyamoya disease is significantly better than that of indirect bypass,but the difference is not statistically significant[Odds Ratio=2.10,95%Confidence Interval(0.26,17.16),P=0.49].Conclusion(s):1.For adult moyamoya disease,the effect of direct bypass is better than that of indirect bypass;2.For adult moyamoya disease,the incidence of stroke in direct bypass may be lower than that in indirect bypass during postoperative follow-up.Although this difference is not statistically significant,it illustrates a trend that is beneficial3.Compared with indirect bypass,patients who undergo direct bypass or combined bypass can get more benefits from them.