Analysis Of Clinical Features And Risk Factors For Rebleeding After Revascularization In Patients With Hemorrhagic Moyamoya Disease

Objective:By retrospectively analyzing the clinical data of patients with hemorrhagic moyamoya disease,explore the clinical characteristics of patients with rebleeding after revascularization and the risk factors that may be related to rebleeding,and guide the clinical prevention and treatment of patients with moyamoya disease at risk of rebleeding jobs.Methods:Collected and retrospectively analyzed clinical data of patients diagnosed with cerebral hemorrhage due to moyamoya disease at the First Affiliated Hospital of Nanchang University from January 2012 to December 2018.All patients were in stable phase.Intracranial and external vascular reconstruction includes direct bypass,indirect bypass and combined bypass surgery.According to the postoperative follow-up with or without rebleeding,they were divided into a bleeding group and a non-bleeding group.Compare the gender,age,smoking and drinking,whether they have hypertension,history of long-term dizziness and headache,aneurysm,and first bleeding The shape of the hematoma at that time,the dilation of the anterior choroidal artery,the dilatation of the posterior communicating artery,and the time interval between the first bleeding and the first operation have no effect on the postoperative bleeding.First,the above factors are tested by single factor analysis,and then the statistically significant related factors are analyzed by binary multi-factor Logistic stepwise regression analysis to determine the relevant risk factors affecting rebleeding after operation.Results:Statistics showed that 180 cases met the standard and 127 cases were followed up,of which the incidence rate of rebleeding was 17.3%(22/127)and 7(31.8%)died of rebleeding.Univariate analysis showed That hypertension,headache and dizziness for a long time(over 6 months),aneurysm,irregular hematoma shape,anteriorchoroidal artery dilatation and posterior communicating artery dilatation were statistically significant(P < 0.05).Multivariate binomial Logistic stepwise regression analysis showed that hypertension,a long history of headach and dizziness,and aneurysm were no longer the relevant risk factors for rebleeding after revascularization,while 57(44.9%)patients had irregular hematoma shape after primary hemorrhage(OR=3.554,95%CI:1.083~11.667,P=0.037),45(35.4%)cases of anterior choroidal artery dilatation or extension(OR = 3.639,95% CI: 1.187 ~11.155,P =0.024),52(40.9%)cases of posterior communicating artery dilatation or extension(OR = 4.729,95% CI: 1.448 ~ 15.445,P = 0.010)are independent risk factors for rebleeding.Conclusion:Dizziness and headache is the most common clinical symptom in patients with hemorrhagic moyamoya disease after revascularization,Mortality after rebleeding is high.dilatation or extension of anterior choroidal artery and dilatation or extension of posterior communicating artery may be independent risk factors for rebleeding after revascularization for hemorrhagic moyamoya disease.