The impact of hypertension on clinical outcomes in moyamoya disease: a multicenter, propensity score-matched analysis.
HTN
Moyamoya
Multicenter
Stroke
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
13 Sep 2024
13 Sep 2024
Historique:
received:
24
07
2024
accepted:
03
09
2024
medline:
13
9
2024
pubmed:
13
9
2024
entrez:
13
9
2024
Statut:
epublish
Résumé
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. 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. 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). 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 39269654
doi: 10.1007/s00701-024-06254-0
pii: 10.1007/s00701-024-06254-0
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
366Informations de copyright
© 2024. The Author(s).
Références
Amlie-Lefond C, Ellenbogen RG (2015) Factors associated with the presentation of moyamoya in childhood. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc 24(6):1204–1210. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.01.018
doi: 10.1016/j.jstrokecerebrovasdis.2015.01.018
Amoah J, Stuart EA, Cosgrove SE et al (2020) Comparing propensity score methods versus traditional regression analysis for the evaluation of observational data: a case study evaluating the treatment of gram-negative bloodstream infections. Clin Infect Dis Off Publ Infect Dis Soc Am 71(9):e497–e505. https://doi.org/10.1093/cid/ciaa169
doi: 10.1093/cid/ciaa169
Anim JI, Kofi AD (1989) Hypertension, cerebral vascular changes and stroke in Ghana: cerebral atherosclerosis and stroke. East Afr Med J 66(7):468–475
pubmed: 2606028
Chiu D, Shedden P, Bratina P, Grotta JC (1998) Clinical features of moyamoya disease in the United States. Stroke 29(7):1347–1351. https://doi.org/10.1161/01.str.29.7.1347
doi: 10.1161/01.str.29.7.1347
pubmed: 9660385
Cuschieri S (2019) The STROBE guidelines. Saudi J Anaesth 13(Suppl 1):S31–S34. https://doi.org/10.4103/sja.SJA_543_18
doi: 10.4103/sja.SJA_543_18
pubmed: 30930717
pmcid: 6398292
El Naamani K, Chen CJ, Jabre R et al (2024) Direct versus indirect revascularization for moyamoya: a large multicenter study. J Neurol Neurosurg Psychiatry 95(3):256–263. https://doi.org/10.1136/jnnp-2022-329176
doi: 10.1136/jnnp-2022-329176
pubmed: 37673641
Ellenga Mbolla BF, Gombet TR, Atipo-Ibara BI, Etitiele F, Kimbally-Kaky G (2012) Impact of severe hypertension in acute heart failure in Brazzaville (Congo). Med Sante Trop 22(1):98–99. https://doi.org/10.1684/mst.2012.0017
doi: 10.1684/mst.2012.0017
Ewen E, Zhang Z, Kolm P et al (2009) The risk of cardiovascular events in primary care patients following an episode of severe hypertension. J Clin Hypertens Greenwich Conn 11(4):175–182. https://doi.org/10.1111/j.1751-7176.2009.00097.x
doi: 10.1111/j.1751-7176.2009.00097.x
FastStats. April 29, 2024. https://www.cdc.gov/nchs/fastats/hypertension.htm . Accessed 22 June 2024
Hypertension China 2023 country profile. https://www.who.int/publications/m/item/hypertension-chn-2023-country-profile . Accessed 22 June 2024
Imputing Missing Data with R; MICE package | DataScience+. https://datascienceplus.com/imputing-missing-data-with-r-mice-package/ . Accessed 10 Aug 2024
Kim JS (2016) Moyamoya disease: epidemiology, clinical features, and diagnosis. J Stroke 18(1):2–11. https://doi.org/10.5853/jos.2015.01627
doi: 10.5853/jos.2015.01627
pubmed: 26846755
pmcid: 4747069
Kuwayama F, Hamasaki Y, Shinagawa T et al (2001) Moyamoya disease complicated with renal artery stenosis and nephrotic syndrome: reversal of nephrotic syndrome after nephrectomy. J Pediatr 138(3):418–420. https://doi.org/10.1067/mpd.2001.111330
doi: 10.1067/mpd.2001.111330
pubmed: 11241054
Leuven E, Sianesi B PSMATCH2: Stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing. Stat Softw Compon. Published online February 1, 2018. https://ideas.repec.org//c/boc/bocode/s432001.html . Accessed 21 June 2024
Liu X, Zhang D, Shuo W, Zhao Y, Wang R, Zhao J (2013) Long term outcome after conservative and surgical treatment of haemorrhagic moyamoya disease. J Neurol Neurosurg Psychiatry 84(3):258–265. https://doi.org/10.1136/jnnp-2012-302236
doi: 10.1136/jnnp-2012-302236
pubmed: 23012444
Ma Y, Zhao M, Deng X et al (2020) Comparison of clinical outcomes and characteristics between patients with and without hypertension in moyamoya disease. J Clin Neurosci Off J Neurosurg Soc Australas 75:163–167. https://doi.org/10.1016/j.jocn.2019.12.016
doi: 10.1016/j.jocn.2019.12.016
Macyszyn L, Attiah M, Ma TS et al (2017) Direct versus indirect revascularization procedures for moyamoya disease: a comparative effectiveness study. J Neurosurg 126(5):1523–1529. https://doi.org/10.3171/2015.8.JNS15504
doi: 10.3171/2015.8.JNS15504
pubmed: 27471892
Mourad JJ (2013) Severe hypertension: definition and patients profiles. Rev Prat 63(5):672–676
pubmed: 23789495
van der Vliet JA, Zeilstra DJ, Van Roye SF, Merx JL, Assmann KJ (1994) Renal artery stenosis in moyamoya syndrome. J Cardiovasc Surg (Torino) 35(5):441–443
pubmed: 7995838
Scott RM, Smith ER (2009) Moyamoya disease and moyamoya syndrome. N Engl J Med 360(12):1226–1237. https://doi.org/10.1056/NEJMra0804622
doi: 10.1056/NEJMra0804622
pubmed: 19297575
Shang S, Zhou D, Ya J et al (2020) Progress in moyamoya disease. Neurosurg Rev 43(2):371–382. https://doi.org/10.1007/s10143-018-0994-5
doi: 10.1007/s10143-018-0994-5
pubmed: 29911252
Sobey CG, Faraci FM (2001) Novel mechanisms contributing to cerebral vascular dysfunction during chronic hypertension. Curr Hypertens Rep 3(6):517–523. https://doi.org/10.1007/s11906-001-0015-9
doi: 10.1007/s11906-001-0015-9
pubmed: 11734099
Suzuki J, Takaku A (1969) Cerebrovascular, “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20(3):288–299. https://doi.org/10.1001/archneur.1969.00480090076012
doi: 10.1001/archneur.1969.00480090076012
pubmed: 5775283
Wang X, Zhang Z, Wang Y et al (2021) Clinical and genetic risk factors of long-term outcomes after encephaloduroarteriosynangiosis in moyamoya disease in China. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc 30(7):105847. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105847
doi: 10.1016/j.jstrokecerebrovasdis.2021.105847
Wei W, Chen X, Yu J, Li XQ (2019) Risk factors for postoperative stroke in adults patients with moyamoya disease: a systematic review with meta-analysis. BMC Neurol 19(1):98. https://doi.org/10.1186/s12883-019-1327-1
doi: 10.1186/s12883-019-1327-1
pubmed: 31092214
pmcid: 6518622
Whelton PK, Carey RM, Aronow WS et al (2018) ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertens Dallas Tex 71(6):1269–1324. https://doi.org/10.1161/HYP.0000000000000066
doi: 10.1161/HYP.0000000000000066
Yamada I, Himeno Y, Matsushima Y, Shibuya H (2000) Renal artery lesions in patients with moyamoya disease: angiographic findings. Stroke 31(3):733–737. https://doi.org/10.1161/01.str.31.3.733
doi: 10.1161/01.str.31.3.733
pubmed: 10700512
Zhang M, Shi Y, Zhou B et al (2023) Prevalence, awareness, treatment, and control of hypertension in China, 2004–18: findings from six rounds of a national survey. BMJ 380:e071952. https://doi.org/10.1136/bmj-2022-071952
doi: 10.1136/bmj-2022-071952
pubmed: 36631148
pmcid: 10498511