Clinical outcome after 450 revascularization procedures for moyamoya disease

Guzman, Raphael; Lee, Marco; Achrol, Achal S.; Bell-Stephens, Teresa; Kelly, Michael; M., Huy; Marks, Michael P.; Steinberg, Gary K.

doi:10.3171/2009.4.jns081649

Cited by 390 publications

(305 citation statements)

References 47 publications

Supporting

Mentioning

271

Contrasting

Unclassified

Order By: Relevance

“…18,19,27,34,37 In adult-onset MMD, revascularization surgery is selectively recommended for patients with ischemic symptoms and hemodynamic compromise. 7,31 However, the efficacy of surgery for the hemorrhagic subtype of MMD remains inconclusive, 1,5,11,13,21,28,40 and the clinical course in asymptomatic patients who do not undergo surgery is not known. 18,19,22,23 Thus, there are still limitations to predicting the prognosis and determining the treatment strategy.…”

mentioning

confidence: 99%

“…36 Its presentation exhibits a bimodal distribution with age: children mostly exhibit an ischemic presentation, and adults usually present with hemorrhage or ischemia. 6,7,9,16,19,36 Although the pathogenesis and natural course are not yet known, revascularization surgery has been satisfactory for patients with ischemic symptoms. 2,3,5,7,8,18,22,24,34 For pediatric MMD, revascularization surgery is universally recommended, regardless of the severity of MMD, because most symptoms are ischemic, and children's brains are still developing.…”

mentioning

confidence: 99%

“…6,7,9,16,19,36 Although the pathogenesis and natural course are not yet known, revascularization surgery has been satisfactory for patients with ischemic symptoms. 2,3,5,7,8,18,22,24,34 For pediatric MMD, revascularization surgery is universally recommended, regardless of the severity of MMD, because most symptoms are ischemic, and children's brains are still developing. 18,19,27,34,37 In adult-onset MMD, revascularization surgery is selectively recommended for patients with ischemic symptoms and hemodynamic compromise.…”

mentioning

confidence: 99%

See 2 more Smart Citations

The natural clinical course of hemodynamically stable adult moyamoya disease

Cho¹,

Chung²,

Kim³

et al. 2015

JNS

View full text Add to dashboard Cite

OBJect Moyamoya disease (MMD) is a rare cerebrovascular disease and its natural history is still unclear. The authors aimed to investigate the natural course of hemodynamically stable cases of adult MMD, with the analysis of stroke risk factors. MetHODS Two hundred forty-one patients were included in this retrospective study. One hundred sixty-six (68.9%) were female, and mean age (± SD) at first visit was 41.3 ± 12.0 years (range 18-69 years). Unilateral involvement was identified in 33 patients, and 19 patients (7.9%) had a family history of MMD. According to the clinical presentations, patients were classified into hemorrhagic (n = 62, 25.7%), ischemic (n = 144, 59.8%), and asymptomatic (n = 35, 14.5%) groups. The mean duration of follow-up was 82.5 ± 62.9 months (range 7.3-347.0 months). reSultS The annual stroke risk was 4.5%, and the annual risks of rebleeding in the hemorrhagic group and recurrent ischemic events in the ischemic group were 4.3% and 3.0%, respectively. There was no significant difference in cumulative stroke risk between the 3 groups (p = 0.461). Risk factors included thyroid disease for overall strokes (HR 2.56, 95% CI 1.16-5.67), initial hemorrhagic presentation for hemorrhagic strokes (HR 2.53, 95% CI 1.24-5.17), and initial ischemic presentation for ischemic strokes (HR 2.69, 95% CI 1.15-6.27). Familial MMD was a common risk factor for all types of stroke. Among the 3 clinical groups, the hemorrhagic group showed the worst clinical status at discharge and at most recent follow-up. Twenty-three patients (9.5%) eventually underwent revascularization surgery. cOncluSiOnS There was no statistically significant difference in the incidence of stroke in the different clinical groups; clinical status, however, was most severe in patients with hemorrhagic presentation. In patients who experienced stroke during the follow-up period, the stroke type tended to correspond to their initial presentation. Close follow-up is needed in patients with thyroid disease and a family history of MMD.http://thejns.org/doi/abs/10.3171/2014.9.JNS132281 KEY WORDS asymptomatic; hemorrhage; ischemia; moyamoya disease; clinical course; vascular disorders aBBreViatiOnS KPS = Karnofsky Performance Scale; MMD = moyamoya disease; mRS = modified Rankin Scale; SAH = subarachnoid hemorrhage; SPECT = single photon emission computed tomography; TIA = transient ischemic attack.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

The natural clinical course of hemodynamically stable adult moyamoya disease

Cho¹,

Chung²,

Kim³

et al. 2015

JNS

View full text Add to dashboard Cite

show abstract

“…12,13 This was, to the best of our knowledge, the longest follow-up study among the previous reports on direct or combined bypass for pediatric moyamoya disease. 3,6,11,13,16 …”

mentioning

confidence: 99%

Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease

Funaki

Takahashi

Takagi

et al. 2013

PED

View full text Add to dashboard Cite

Object In the study of pediatric moyamoya disease, information on long-term social outcomes and risk factors for unfavorable social outcomes remains insufficient. The authors analyzed the long-term results of surgical revascularization for pediatric patients with moyamoya disease to determine whether the involvement of a stenoocclusive lesion in the posterior cerebral artery (PCA), relatively common in pediatric moyamoya disease, represents an underlying predictor for unfavorable social outcomes. Methods Prospectively collected data on 61 consecutive patients with moyamoya disease who had undergone combined bypass surgery were analyzed. Neuroradiological features and other baseline clinical factors were incorporated into univariate and multivariate analyses to determine any association with an unfavorable social outcome, defined as difficulty attending regular school or obtaining regular employment. Results Posterior cerebral artery involvement detected by angiography on admission was noted in 22 (36.1%) of the 61 patients. Follow-up data were acquired in 56 patients (91.8%), and the mean follow-up period was 15.8 years. While transient ischemic attacks were eliminated in 52 (92.9%) of these 56 patients after surgery, and late-onset ischemic stroke was observed in only 1 patient during the follow-up period, 10 (17.9%) experienced an unfavorable social outcome. Although younger age at onset, longer duration between onset and surgery, infarction present on preoperative neuroradiological images, and PCA involvement had been identified as risk factors for an unfavorable social outcome in univariate analysis, only infarction present on preoperative images and PCA involvement remained statistically significant after multivariate adjustment. Conclusions Posterior cerebral artery involvement can be considered one of the underlying risk factors for unfavorable social outcome and should be studied further to improve social outcome in pediatric moyamoya disease.

show abstract

“…In MMD with unilateral STA-MCA bypass, symptomatic cerebral ischemia in the contralateral hemisphere occurs in about 3-14% of patients. [4][5][6][7] We herein presented a case of childhood-onset bilateral MMD, which developed transient cerebral ischemia in the contralateral hemisphere after STA-MCA bypass in her young adulthood. Transient weakness of the left extremities and acute cerebral infarctions in the contralateral hemisphere were observed from postoperative Day 1 to Day 6.…”

Section: Introductionmentioning

confidence: 99%

Cerebral ischemia at early postoperative period of direct revascularization for moyamoya disease: a case report and literature review

Chen¹,

Ma²,

Chen³

et al. 2017

View full text Add to dashboard Cite

Hypoperfusion and hyperperfusion could be causes of early postoperative complications that lead to neurological deterioration in patients with moyamoya diseases (MMD) after superficial temporal artery (STA) and middle cerebral artery (MCA) anastomosis. Here, the authors described a case of child-onset bilateral MMD that manifested transient cerebral ischemia in the contralateral hemisphere after left STA-MCA bypass in young adulthood. A new onset of cerebral ischemia in the contralateral hemisphere and transient neurological deterioration suggested the fragile hemodynamics of MMD during early perioperative period. Serial evaluation of postoperative cerebral hemodynamics and perfusion might facilitate targeted management in patients with unstable or advanced MMD. Topic: StrokeThis is an open access article distributed under the terms of the Creative Commons AttributionNonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

show abstract

Clinical outcome after 450 revascularization procedures for moyamoya disease

Abstract: Revascularization surgery in patients with MMD carries a low risk, is effective at preventing future ischemic events, and improves quality of life. Patients in whom symptomatic MMD is diagnosed should be offered revascularization surgery.

Cited by 390 publications

References 47 publications

The natural clinical course of hemodynamically stable adult moyamoya disease

The natural clinical course of hemodynamically stable adult moyamoya disease

Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease

Cerebral ischemia at early postoperative period of direct revascularization for moyamoya disease: a case report and literature review

Contact Info

Product

Resources

About