1070. Dl-3-N-butylphthalide Alleviates Neurological Deficit after Combined Extracranial-Intracranial Revascularization for Moyamoya Disease: A Propensity Score-Matched Analysis

Authors: Zongze Li; Li Ma, MD; Yuanli Zhao, MD (Beijing, China)

Introduction:

Postoperative neurological deficits would impair the overall outcome of patients with moyamoya disease (MMD) after revascularization surgery. Dl-3-N-butylphthalide (NBP) is approved for the treatment of ischemic stroke in China. This pilot study evaluated the effect of NBP on perioperative stroke and neurological deficits in MMD.

Methods:

From 213 hemispheres of 164 patients with combined revascularization surgery for MMD, NBP (25mg twice daily) was administrated for 7 postoperative days in 49 patients. The incidence of perioperative stroke and transient neurological deficit (TND), and the severity of neurological deficits were compared between 49 propensity score-matched case pairs with or without NBP treatment. Subgroup analyses by onset-type and preoperative neurological status were also performed to determine specific patients who might benefit from the NBP administration.

Results:

Among the overall cohort, baseline characteristics differed in preoperative stroke and modified Rankin Scale (mRS) score between patients with or without NBP administration. In the 49 propensity score-matched pairs, postoperative stroke was observed in 11 patients and TND occurred in 21 patients, without difference between the two groups. However, the TND was less severe in NBP-treated group (P=0.01). At 1 month after surgery, the neurological outcome was more favorable (P=0.001) and the disability-free recovery rate was higher in patients with NBP treatment (P<0.001). More patients experienced an improved neurological function after NBP administration (P<0.001). Multivariable analysis revealed that NBP administration was associated with decreased severity of TND (OR, 0.28; P=0.02), improved neurological function (OR, 65.29; P=0.04) and lower postoperative mRS score (OR, 0.06; P<0.001). These beneficial effects of NBP remained significant in ischemic MMD and patients with preoperative mRS≥2.

Conclusion:

Postoperative NBP administration may alleviate perioperative neurological deficits of MMD, especially in patients with ischemic MMD and unfavorable preoperative status. It might be feasible to propose randomized controlled trials to assess this potential benefit in MMD.