| Purpose: Moyamoya disease is a rare cerebrovascular disease with progressive intracranial stenosis and abnormal vascular network formation.Some patients may have aneurysms.This article analyzes the clinical characteristics of adult moyamoya disease and moyamoya syndrome patients,looks for risk factors that affect prognosis,and discusses possible treatment methods.Methods: Patients with moyamoya disease and moyamoya syndrome with aneurysm who were treated in our hospital from 2011 to 2019 were collected,and their clinical baseline data,past medical history data,imaging characteristics,and admission and discharge evaluation data and treatment methods and recovery status were collected;patients with moyamoya diseass and moyamoya syndrome without aneurysm hospitalized during the same period were used as controls.The first part analyzes the general characteristics and prognostic differences of the two groups,and the subgroup analyzes the characteristics and prognosis of the aneurysm group.The second part is the analysis of risk factors of moyamoya disease and moyamoya syndrome.Result: The first part: 1.This study included 40 patients with moyamoya disease and moyamoya syndrome accompanied by aneurysms and 196 patients without aneurysms.The admission mRS score was significantly higher in the aneurysm group than in the non-aneurysm group(P= 0.034).The proportion of cerebral hemorrhage types in the aneurysm group was significantly higher than in the non-aneurysm group(P<0.001).In terms of type,cerebral hemorrhage is most common in mixed cerebral hemorrhage.Among them,the aneurysm group has more SAH(P= 0.030);long-term follow-up indicates that the aneurysm group has a re-stroke rate(P= 0.009)and mortality(P= 0.022)significantly higher than the non-aneurysm group;2.When the aneurysm group was grouped according to the nature of the aneurysm for prognostic analysis,there were no statistical differences in mRS scores,recurrent strokes,and mortality in the two groups;when the aneurysm group was sub-analyzed by surgery or not,there were no deaths in the surgery group,and deaths in the aneurysm group occurred in people who were not treated with surgery,and the difference between the above is significant(P=0.004).The second part: 1.Univariate analysis of recurrent stroke patients found that combined with aneurysm(P= 0.009)could lead to higher recurrence stroke rate,and surgical treatment can reduce recurrence stroke rate(P=0.023);based on multi-factor logistic analysis,all patients were found to be male(OR=4.46,95% CI 1.105,P=0.036),aneurysms(OR=4.018,95% CI 1.472-10.969,P=0.007)are independent risk factors for recurrent stroke,and surgery is a protective factor(OR=0.243,95% CI 0.097-0.610,P=0.003);2.Subgroup analysis of patients with ischemic and patients with hemorrhagic showed that surgery can reduce the recurrent stroke rate in patients with ischemic motility(OR=0.151,95% CI 0.026-0.890,P= 0.037).No statistical difference was observed in hemorrhagic patients(OR=0.366,95% CI 0.110-1.210,P=0.099).Conclusion: The reports of moyamoya disease combined with aneurysm are increasing,and it is one of the important causes of cerebral hemorrhage in moyamoya disease patients,and the clinical characteristics are significantly different from those without aneurysm.There are currently no standard recommended therapies.Surgery can reduce mortality to some extent,but it does not significantly reduce the recurrence of stroke.Further research is needed. |
