| Background:At present,cerebral revasculopathy is still the main treatment method for moyamoya disease,which can effectively improve cerebral perfusion,prevent stroke and improve long-term neurological function.Surgical treatment can be divided into direct cerebral revascularization,indirect revascularization and combined revascularization according to the characteristics of different regions.Japanese guidelines for the management of moyamoya disease(2021)indicate that indirect revascularization alone is not sufficient for adult patients with moyamoya disease and that direct or combined revascularization surgery is required to improve cerebral perfusion.Adequate control of blood pressure and fluid replacement,maintenance of normal capnia and antiplatelet therapy are required in the perioperative period to avoid intraoperative and contralateral complications of cerebrovascular events.Our research center generally adopts combined cerebral revasculoplasty for adult patients with moyamoya disease,which not only provides timely blood supply to ischemic brain functional areas,but also provides a basis for improving cerebral perfusion in a larger range in the long term.However,whether,when and when to use aspirin after surgery remains controversial among neurosurgeons in different regions,and the results of published studies are also different.The purpose of this study was to explore the effectiveness and safety of regular application of aspirin in patients with ischemic moyamoya disease after combined cerebral revascularization,and to provide theoretical guidance for long-term postoperative medication for patients in our center.Objective:To analyze the effect and risk of regular use of aspirin in patients with ischemic moyamoya disease after combined cerebral revascularization.Methods:A total of 715 patients were selected from October 2019 to September 2021 who were diagnosed with moyamoya disease by DSA in the Moyamoya Disease Diagnosis and Treatment Research Center of Henan Provincial People’s Hospital,and underwent combined cerebral revascularization by the same surgeon.Two physicians screened the patients according to the established inclusion/exclusion criteria,and the patients were divided into groups according to whether they were willing to take aspirin orally after surgery(non-randomized controlled study).The aspirin group was the observation group,and 133 patients were eventually enrolled.71 patients were included in the non-aspirin group as the control group.Preoperative data of two groups were collected,such as age,sex,initial symptoms,family history of stroke,mRS score,Suzuki stage,cerebral perfusion stage,etc.Postoperative data of the two groups were collected,such as mRS score,cerebral perfusion stage and improvement rate,Matsushima grading,bypass patency rate,postoperative complications,etc.,and then statistical analysis was conducted to evaluate whether there was a difference in prognosis between the two groups.Results:1.Comparison of general dataIn the control group,there were 40 male patients(56.3%)and 31 female patients(43.7%).Of the133 patients in the observation group,68(51.1%)were male and 65(48.9%)were female.The control group was 48(34,50)years old and the observation group was 47(37,54)years old.Statistical analysis showed that there were no significant differences in gender,age,initial symptoms,preoperative secondary diagnosis,family history of cerebrovascular disease,smoking history and drinking history between the two groups(P > 0.05).2.Preoperative data analysisIn the control group,there were 9 patients with Suzuki stage 2(12.7%),36 patients with Suzuki Stage 3(50.7%),20 patients with Suzuki Stage 4(28.2%),and 6 patients with Suzuki Stage 5(8.5%).In the observation group of this study,there were 21 patients(15.8%)with Suzuki stage 2,61 patients(45.9%)with Suzuki Stage 3,43 patients(32.3%)with Suzuki Stage 4 and 8 patients(6.0%)with Suzuki Stage 5.There was no significant difference in Suzuki stage between the two groups(Z =-0.191,P=0.849>0.05).There were no significant differences in mRS score,Suzuki stage,cerebral perfusion stage and surgical side between the control group and the observation group(P > 0.05).3.Comparison between groups 6 months after surgeryIn the control group,48 patients(67.6%)scored 0-1,22 patients(31.0%)scored 2-3,and 1patient(1.4%)scored 4-5.In the observation group,108 patients(81.2%)had mRS score of 0-1,20 patients(15.0%)had mRS score of 2-3,and 5 patients(3.8%)had mRS score of 4-5.The overall grade of the observation group was better than that of the control group(Z=-2.015,P=0.044).There were no significant differences in cerebral perfusion stage,cerebral perfusion improvement rate,Matsushima grading and bypass patency rate between the control group and the observation group 6 months after operation(P > 0.05).4.Comparison within groups 6 months after surgeryIn the preoperative control group,39 patients(54.9%)had mRS score 0-1,29 patients(40.8%)had mRS score 2-3,and 3 patients(4.2%)had mRS score 4-5.Half a year after the operation,mRS scores were divided into 48 cases(67.6%)from 0-1,22 cases(31.0%)from 2-3,and 1 case(1.4%)from 4-5.The differences between the preoperative and postoperative groups were statistically significant(Z =-2.529,P=0.011).In the observation group,87 patients(65.4%)had mRS score 0-1,39 patients(29.3%)had mRS score 2-3,and 7 patients(5.3%)had mRS score 4-5.Half a year after the operation,mRS score was divided into 108 cases(81.2%)from 0-1,20 cases(15.0%)from 2-3,and 5 cases(3.8%)from 4-5.The difference between the observation group before and after the operation was statistically significant(Z =-3.571,P<0.001).There were 7 patients(9.9%)with stage 1 cerebral perfusion,19 patients(26.8%)with stage 2cerebral perfusion,23 patients(32.4%)with stage 3 cerebral perfusion,and 22 patients(30.9%)with stage4 cerebral perfusion in the preoperative control group.There were 12 cases(16.9%)in stage 1,28 cases(39.4%)in stage 2,21 cases(29.6%)in stage 3,and 10 cases(14.1%)in stage 4 half a year after the operation.There were statistically significant differences between the control group before and after operation(Z =-5.801,P < 0.001).In the observation group,there were 11 patients(8.3%)with stage 1cerebral perfusion,42 patients(31.6%)with stage 2 cerebral perfusion,45 patients(33.8%)with stage 3cerebral perfusion,and 35 patients(26.3%)with stage 4 cerebral perfusion.There were 29 patients(21.8%)with stage 1 cerebral perfusion,47 patients(35.3%)with stage 2 cerebral perfusion,36 patients(27.1%)with stage 3 cerebral perfusion,and 21 patients(15.8%)with stage 4 cerebral perfusion six months after the operation.The difference between the observation group before and after operation was statistically significant(Z=-5.625,P < 0.001).5.Comparison of postoperative complications between groupsTIA is the first symptom before surgery,and the frequency of postoperative attacks decreases,but there are still intermittent attacks,so it is included in the complications.In the control group,22 patients(31.0%)had TIA within half a year after surgery.In the observation group,24 patients(18.1%)had TIA within half a year after surgery,and the difference between the two groups was statistically significant(χ2=4.439,P =0.035).In terms of serious prognostic complications,in the control group,recurrent cerebral infarction occurred in 3 cases(4.2%),cerebral hemorrhage in 2 cases(2.8%),and epilepsy in 2 cases(2.8%).There were 7 cases(5.3%)of recurrent cerebral infarction,3 cases(2.2%)of cerebral hemorrhage,and 2 cases(1.5%)of epilepsy in the observation group,and the difference between the two groups was not statistically significant(P > 0.05).Conclusion:1.Oral administration of aspirin(100mg/d)within six months after surgery can significantly reduce mRS score and TIA attack,but can not significantly improve operation-side cerebral perfusion,improve the Matsushima grade and bypass patency rate,and the impact on long-term prognosis cannot be assessed;2.Regular oral administration of aspirin(100mg/ day)within six months after surgery does not increase the risk of ischemic or hemorrhagic stroke. |
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