Clinical Features Of Adult Hemorrhagic Moyamoya Disease And The Effect Of Revascularization On Its Prognosis

Background: Whether surgical revascularization can prevent recurrent hemorrhage in hemorrhagic moyamoya disease（HMD）patients remains a matter of debate.The purpose of this study was to analyze the clinical characteristics of hemorrhagic moyamoya disease,and to explore the efficacy difference between revascularization and conservative treatment of hemorrhagic moyamoya disease,so as to provide theoretical basis for the treatment of hemorrhagic moyamoya disease,and reduce the occurrence of rebleeding.Methods: We retrospectively enrolled 322 adult HMD patients,including 133 in revascularization group and 189 in conservative group.The revascularization group included patients who underwent combined（n=97）or indirect revascularization alone（n=36）.Ninety-two and forty-one patients underwent unilateral and bilateral revascularization respectively.The modified Rankin scale（mRS）was used to assess the functional status.The comparison was made based on initial treatment paradigm among two categories: 1.revascularization vs.conservative,2.unilateral vs.bilateral revascularization.Results: There were no significant differences in baseline data such as gender,mRS score at first hemorrhage and median follow-up time between the two groups（P > 0.05）.There was no significant difference between the average interval time from first bleeding to rebleeding in the conservative group（51.9 months）and the average follow-up time of non-bleeding patients in the bypass group（47.1 months）,P > 0.05.The rebleeding rate was significantly lower in revascularization group than that in conservative group（14.3% vs.27.0%,P=0.007）.As for the functional outcomes,the average mRS was significantly better in revascularization group（1.7 ± 1.5）than that in conservative group（2.8 ± 1.9）（P<0.001）.The death rate in revascularization group was8.3%（11/133）,comparing to 20.1%（38/189）in conservative group（P=0.004）.Referring to the first hemorrhage,the ipsilateral rebleeding rate in the revascularization group was significantly lower than that in the conservative group（8.3% vs 16.4%）,P <0.05;and contralateral rebleeding had no significant difference（6.0% vs 10.6%）,P >0.05.While comparing between unilateral and bilateral revascularization within the revascularization group,the result demonstrated lower annual rebleeding rate in bilateral group（0.5%/side-year）than that in unilateral group（3.3%/side-year）（P=0.001）.Conclusions: This study proved the better treatment efficacy of surgical revascularization than that of conservative treatment in HMD patients,regarding both in rebleeding rate and mortality rate.Furthermore,bilateral revascularization seems more effective in preventing rebleeding than unilateral revascularization.