Yeonhu Lee
Jin Soo Lee
*
Ji Man Hong
The final, formatted version of the article will be published soon.
ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Volume 15 - 2024 |
doi: 10.3389/fneur.2024.1479379
This article is part of the Research Topic Intracranial aneurysms, AVM and other vascular malformations, and connective tissue disorders as potential causes of stroke: Advances in diagnosis and therapeutics including novel neurosurgical techniques View all 13 articles
Multiple Burr Hole and Erythropoietin Combination Therapy: Optimal Early Surgical Intervention for Patients with Acute Stroke Episode of Moyamoya Disease or Moyamoya Syndrome
Provisionally accepted- School of Medicine, Ajou University, Suweon, Republic of Korea
Objective: The optimal timing of bypass surgery for patients with moyamoya disease (MMD) or moyamoya syndrome (MMS) following an acute stroke episode remains unclear, mainly owing to the risk of postoperative complications. In this study, we aim to validate the safety and efficacy of early intervention using multiple burr hole (MBH) and erythropoietin (EPO) therapy, thereby refining the management strategy for patients with acute stroke episode of MMD or MMS. Methods: We retrospectively analyzed data from 70 patients with MMD or MMS who underwent MBH and EPO therapy. The cohort was divided based on the time interval between the latest neurological deterioration and surgery: early (<30 days) and later (≥30 days) groups. We evaluated and compared perioperative clinical parameters and the extent of neovascularization on a 6-month postoperative angiography. Long-term clinical outcomes, including transient ischemic attack (TIA), infarction, hemorrhage, and seizure, were also analyzed during the follow-up period. Results: In the cohort, 34 patients (48.6%) were in the early group, whereas 36 (51.4%) were in the later group. The 6-month follow-up angiography demonstrated that 34/44 hemispheres (72.3%) in the early group exhibited successful neovascularization (≥2/3 of MCA territories) compared with the 19/47 (43.2%) hemispheres in the later group (odds ratio [OR] = 3.44; 95% confidence interval [CI]: 1.45-8.45; p < 0.01). In addition, a notable reduction (≥50%) in basal moyamoya vessels was observed in 30/44 hemispheres (63.8%) from the early group vs. 12/47 (27.3%) hemispheres from the later group (OR = 4.71; 95% CI: 1.97-11.82; p < 0.001). During the average follow-up of 56.5 months, only six patients experienced infarction or hemorrhage. Our dataset suggests that MBH and EPO combination therapy is an effective, minimally invasive, and acceptable treatment, even in the early period of patients with MMD or MMS following an acute stroke episode.
Keywords: Moyamoya Disease, Moyamoya syndrome, multiple burr hole, Erythropoietin, Surgical intervention
Received: 12 Aug 2024; Accepted: 13 Dec 2024.
Copyright: © 2024 Lee, Lee, Lee, Hong and Lim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jin Soo Lee, School of Medicine, Ajou University, Suweon, Republic of Korea
Seong-Joon Lee, School of Medicine, Ajou University, Suweon, Republic of Korea
Yong Cheol Lim, School of Medicine, Ajou University, Suweon, Republic of Korea
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.