もやもや病に対する抗血小板薬のエビデンス

Evidence for Antiplatelet Drug Therapy for Moyamoya Disease

Point

・これまで，もやもや病（MMD）患者の脳卒中予防における抗血小板薬の使用を調査した無作為化臨床試験は実施されていない．ほとんどの報告が後ろ向き観察研究，または前向きではあるが小規模なコホート研究である．

・虚血型MMDに対する抗血小板薬投与の有効性は限定的であるが，経頭蓋超音波ドップラーで微小塞栓信号が認められた患者では，脳梗塞予防効果が期待できる．

・抗血小板薬投与がMMD患者において出血性脳卒中の発症リスクを増やすというデータはなく，バイパス術後ではバイパス血管開存率を上げる可能性が示されている．

・抗血小板薬のなかでもシロスタゾールは，MMD患者における脳血流増加作用，認知機能低下抑制作用など多面的作用を通じて，臨床的に有用な効果をもたらす可能性がある．

　Currently, no randomized clinical trials have investigated the use of antiplatelet drugs to prevent stroke in patients with Moyamoya disease（MMD）. Notably, most of these studies were retrospective observational or prospective with small cohorts. Although the effectiveness of antiplatelet drug administration for ischemic MMD is limited, patients with microembolic signals detected using transcranial Doppler ultrasound may benefit from the prevention of cerebral infarction. There are no data that the administration of antiplatelet drugs increases the risk of hemorrhagic stroke in patients with MMD. However, administration of antiplatelet drugs may increase the patency rate of bypass blood vessels after bypass surgery. Among antiplatelet drugs, cilostazol has a clinically beneficial effect in patients with MMD through its multifaceted effects, such as increasing cerebral blood flow and inhibiting cognitive decline.