JAM Trial：結果と今後の展望

抄録

Background: Intracranial hemorrhage accounts for one-half of primary manifestations in adult-onset moyamoya disease. The hypothesis that extracranial-intracranial direct bypass reduces hemodynamic burden on fragile moyamoya vessels and thus prevents further bleeding remains unproven
Methods: The Japan Adult Moyamoya Trial is a multicenter, prospective, randomized controlled trial conducted by 22 institutions in Japan since 2001. Adult patients with hemorrhagic moyamoya disease were allocated either to conservative care or bilateral extracranial-intracranial direct bypass, and observed thereafter. All adverse events and rebleeding were monitored as endpoints. Five-year followups of all participants were completed in 2013, and the first results were published in 2014.
Results and Conclusions: Eighty patients were enrolled (surgical, 42; nonsurgical, 38). Incidence rates of primary and secondary events were significantly lower in the surgical group than in the nonsurgical group (3.2%/y versus 8.2%/y; p=0.048, and 2.7%/y versus 7.6%/y; p=0.042, respectively). The hazard ratio of the surgical group was 0.391 for primary endpoints and 0.355 for secondary endpoints. These results, along with those of further follow-up and subgroup analyses, may contribute to better treatment for hemorrhagic moyamoya disease.