Analysis Of Influencing Factors Of Asymptomatic Moyamoya Disease Secondary Stroke In Adults

Objective:To explore the factors influencing the onset of stroke in adult asymptomatic moyamoya disease,and evaluate the risk and prognosis of stroke in these patients through conservative observation or follow-up results of surgical treatment.Methods:Screened 852 patients who were diagnosed with moyamoya disease in the First Affiliated Hospital of Nanchang University from January 2012 to December 2016.Finally,123 adult patients were enrolled,of which 91 received intracranial and extracranial vascular reconstruction,and 32 underwent treatment.Conservative observation is divided into surgical treatment group and conservative treatment group.The patient data was collected in detail through the case system and follow-up,and the collected data was statistically analyzed to compare the clinical progress of the two groups.The main endpoints were intracranial hemorrhage and cerebral infarction.Summarize the imaging factors,stroke risk and prognosis of stroke in adult asymptomatic moyamoya disease.Results:(1)The median follow-up time was 73(25-109)months.During the follow-up,a total of 27 patients(21.9%)had stroke(clinical progression),with an average annual incidence of 3.6%.(2)14 cases in the conservative group showed clinical progress,including 11 cases of intracranial hemorrhage(6 cases of intraventricular hemorrhage,4 cases of cerebral parenchymal hemorrhage,1 case of subarachnoid hemorrhage)and 3 cases of cerebral infarction.In the surgical group,13 cases showed clinical progress,including 10 cases of intracranial hemorrhage(4 cases of intraventricular hemorrhage,4 cases of cerebral parenchymal hemorrhage,2 cases of subarachnoid hemorrhage)and 3 cases of cerebral infarction.(3)During the follow-up period,3 patients(2.4%)died of intracranial hemorrhage,and 12 patients(9.7%)were severely disabled(m RS score ≥3).During the follow-up period,1 patient died of cervical cancer(with a stroke-free survival time of 90 months).The interval between the initial diagnosis of the 27 patients and the onset of stroke was 25-83 months(average 53.5 months).The cumulative risk of stroke at 5 years is 14.6%.(4)Kaplan-Meier curve analysis showed that compared with conservative observations,patients who underwent intracranial and extracranial revascularization had longer survival time without stroke(P <0.001),while diabetes(P = 0.029),hypertension(P <0.001)and Intracranial aneurysm(P = 0.026)can increase the risk of stroke.Cox regression analysis showed that hypertension is an independent risk factor for stroke in patients with asymptomatic moyamoya disease(HR = 2.861,95% CI: 1.168-7.010,P = 0.021);compared with conservative observation,surgical treatment can reduce stroke Risk(HR=0.339,95% CI: 0.131-0.875,P=0.025).Conclusion:(1)Hypertension is an independent risk factor for the onset of stroke in adult asymptomatic moyamoya disease.Intracranial and extracranial vascular reconstruction can reduce the risk of stroke,while gender,age,diabetes,smoking,drinking,CTP-r CBF decline,intracranial aneurysm,There is no significant correlation between spontaneous external carotid artery compensation and stroke-free survival time;(2)Asymptomatic moyamoya disease is not a truly stable disease state,there is a risk of clinical progression,and hemorrhagic stroke is common,requiring close follow-up observation.