The impact of hypertension on clinical outcomes in moyamoya disease: a multicenter, propensity score-matched analysis

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2024年9月13日

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Basel Musmar,
Joanna M. Roy,
Hammam Abdalrazeq,
Elias Atallah,
Kareem El Naamani,
Ching-Jen Chen,
Roland Jabre,
Hassan Saad,
Jonathan A. Grossberg,
Adam A. Dmytriw,
Aman B. Patel,
Mirhojjat Khorasanizadeh,
Christopher S Ogilvy,
Ajith J. Thomas,
Andre Monteiro,
Adnan Siddiqui,
Gustavo M. Cortez,
Ricardo A. Hanel,
Guilherme Porto,
Alejandro M. Spiotta,
Anthony J. Piscopo,
David M. Hasan,
Mohammad Ghorbani,
Joshua Weinberg,
Shahid M. Nimjee,
Kimon Bekelis,
Mohamed M. Salem,
Jan-Karl Burkhardt,
Akli Zetchi,
Charles Matouk,
Brian M. Howard,
Rosalind Lai,
Rose Du,
Rawad Abbas,
Georgios S Sioutas,
Abdelaziz Amllay,
Alfredo Munoz,
Nabeel A. Herial,
Stavropoula I. Tjoumakaris,
Michael Reid Gooch,
Robert H. Rosenwasser,
Pascal Jabbour

摘要

Background

Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive steno-occlusive changes in the internal carotid arteries, leading to an abnormal vascular network. Hypertension is prevalent among MMD patients, raising concerns about its impact on disease outcomes. This study aims to compare the clinical characteristics and outcomes of MMD patients with and without hypertension.

Methods

We conducted a multicenter, retrospective study involving 598 MMD patients who underwent surgical revascularization across 13 academic institutions in North America. Patients were categorized into hypertensive (n=292) and non-hypertensive (n=306) cohorts. Propensity score matching (PSM) was performed to adjust for baseline differences.

Results

The mean age was higher in the hypertension group (46 years vs. 36.8 years, p < 0.001). Hypertensive patients had higher rates of diabetes mellitus (45.2% vs. 10.7%, p < 0.001) and smoking (48.8% vs. 27.1%, p < 0.001). Symptomatic stroke rates were higher in the hypertension group (16% vs. 7.1%; OR: 2.48; 95% CI: 1.39-4.40, p = 0.002) before matching. After PSM, there were no significant differences in symptomatic stroke rates (11.1% vs. 7.7%; OR: 1.5; CI: 0.64-3.47, p = 0.34), perioperative strokes (6.2% vs. 2.1%; OR 3.13; 95% CI: 0.83-11.82, p = 0.09), or good functional outcomes at discharge (93% vs. 92.3%; OR 1.1; 95% CI: 0.45-2.69, p = 0.82).

Conclusion

No significant differences in symptomatic stroke rates, perioperative strokes, or functional outcomes were observed between hypertensive and non-hypertensive Moyamoya patients. Appropriate management can lead to similar outcomes in both groups. Further prospective studies are required to validate these findings.