Effect of direct arterial bypass on the prevention of future stroke in patients with the hemorrhagic variety of moyamoya disease

Kawaguchi, Shoichiro; Okuno, Sachiko; Sakaki, Toshisuke

doi:10.3171/jns.2000.93.3.0397

Cited by 163 publications

(73 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The high associated rebleeding and mortality rates are the major causes of poor outcomes for patients with hemorrhagic MMD. 14,18,26 Therefore, reducing the occurrence of rebleeding is the most important consideration. In this study, 33 (9.9%) of the followed-up 331 patients experienced intracranial hemorrhage, including 25 (41.7%) of 60 conservatively treated patients and 8 (2.9%) of 271 surgically treated patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and long-term outcomes of moyamoya disease: a single-center experience with 528 cases in China

Liu

Zhang

Wang

et al. 2015

JNS

108

View full text Add to dashboard Cite

OBJECT The aim of this study was to describe the baseline clinical features and long-term outcomes of patients with moyamoya disease (MMD) based on a 25-year period at a single center in China. METHODS Data obtained in 528 consecutive patients with MMD treated at the authors' hospital from 1984 to 2010 were reviewed retrospectively. Events of transient ischemic attack, new infarction, and hemorrhage were included. The Kaplan-Meier risk of stroke was calculated. RESULTS The mean (± SD) patient age was 26 ± 13 years (range 2–67 years), and the female/male ratio was 0.9:1. There were 332 cases of ischemia and 196 hemorrhages. Adults had a higher rate of bleeding than children (50.7% vs 14.0%, respectively; p < 0.001). One hundred twenty-two patients were treated conservatively, and 406 patients underwent revascularization procedures. Of 528 patients, 331 (62.7%) had at least 1 year of follow-up (median 39.5 months) and data from these patients were analyzed. Rebleeding and mortality rates in patients with hemorrhagic MMD (n = 104) were higher than in those with ischemic MMD (n = 227) (26.9% vs 2.2% [p < 0.001] and 4.8% vs 0.4% [p < 0.05], respectively). Twenty-five of 60 (41.7%) conservatively treated patients and 8 of 271 (2.9%) surgically treated patients experienced rebleeding events, a difference that was significant in the Kaplan-Meier curve of rebleeding (p < 0.01). An improvement in perfusion was found in 164 of 224 (73.2%) surgically treated patients 1 month after discharge. However, there was no significant difference in the rate of ischemic events in the surgical and conservative groups (18.8% and 28.3%, respectively; p = 0.09). Among the 104 hemorrhagic cases, rebleeding attacks were observed in 25 patients in the nonsurgical group (n = 60) and 3 patients in the surgical group (n = 44) (41.7% and 6.8%, respectively; OR 9.7 [95% CI 2.7–35.0]; p < 0.01). CONCLUSIONS There was no difference in the sex distribution of Chinese patients with MMD. Patients with hemorrhagic MMD had a much higher rate of rebleeding and poorer prognosis than those with the ischemic type. Surgical revascularization procedures can improve cerebral perfusion and have a positive impact in preventing rebleeding in patients with hemorrhagic MMD.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical features and long-term outcomes of moyamoya disease: a single-center experience with 528 cases in China

Liu

Zhang

Wang

et al. 2015

JNS

108

View full text Add to dashboard Cite

show abstract

“…Intracranial hemorrhage is a common in feature in adult patients with MMDs with a mortality rate of approximately 20%, and it is the largest risk factor contributing to the poor prognosis with this entity. 22,23 Hemodynamic stress to the Moyamoya vessels has been suggested as a cause for the hemorrhagic presentation, and some reports showed Moyamoya vessels and aneurysms associated with MMD resolved after bypass surgery. 24,25 The prophylactic effect of bypass surgery against cerebral hemorrhage remains uncertain, and this issue will be clarified by a prospective, randomized trial in Japan (Japan Adult Moyamoya Trial).…”

Section: Patient Characteristics In Each Presentation Of MMDmentioning

confidence: 99%

“Brush Sign” on Susceptibility-Weighted MR Imaging Indicates the Severity of Moyamoya Disease

Horie¹,

Morikawa²,

Nozaki³

et al. 2011

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: SWI is a high spatial resolution MR imaging technique showing magnetic inhomogeneity that could demonstrate increased oxygen extraction in focal cerebral ischemia. The aim of this study was to investigate the characteristics in the signal intensity of DMVs by using SWI and to determine whether this method could indicate the severity of the hemodynamics in MMD by evaluating the correlation between SWI stage and hemodynamics on SPECT.

show abstract

“…Although some reports have demonstrated the effects of direct revascularization surgery to prevent recurrent bleeding [13], or at least subsequent ischemia [20], the long-term efficacy of revascularization surgery following hemorrhage in adult patients remains controversial [2,6,22,27]. On the other hand, moyamoya disease in childhood manifests cerebral infarction more frequently than in adults.…”

Section: Discussionmentioning

confidence: 99%

“…Pediatric patients mainly present with cerebral ischemia and they very rarely bleed [2,4,14,15]. Although the benefits of surgical revascularization for ischemic moyamoya disease have been well recognized, the indications for such treatment in hemorrhagic type to prevent rebleeding have not yet been established [2,6,13,20,22,27]. We herein report three children aged < 10 years presenting with intracerebral hemorrhage associated with moyamoya disease, two of which were accompanied with early ischemic complications followed by revascularization surgery.…”

Section: Introductionmentioning

confidence: 93%

Pediatric moyamoya disease presenting with intracerebral hemorrhage—Report of three cases and review of the literature

Suyama

Yoshida

Takahata

et al. 2008

Clinical Neurology and Neurosurgery

View full text Add to dashboard Cite

Intracerebral hemorrhage in patients with moyamoya disease is rare in children. We report three unique cases of pediatric moyamoya disease with hemorrhagic onset. Two 7-year-old girls and a 9-year-old girl were admitted to our hospital because of intracerebral hemorrhage associated with angiographically verified moyamoya disease. Two of them did not demonstrate either an ischemic episode or cerebral infarct on the magnetic resonance images. A decreased regional cerebral blood flow was revealed on single photon emission computed tomography in two patients, who developed cerebral infarction in the acute stage following hemorrhage. They underwent superficial temporal artery-middle cerebral artery anastomoses combined with encephalo-myo-synangiosis, and have not experienced any further ischemic episodes thereafter. Hemodynamic insufficiency associated with moyamoya disease could cause intracerebral hemorrhage even in children. Adequate management in the acute stage of hemorrhage and revascularization surgery are recommended to prevent 1 cerebral infarction, which may easily occur in pediatric patients with moyamoya disease.

show abstract

Effect of direct arterial bypass on the prevention of future stroke in patients with the hemorrhagic variety of moyamoya disease

Abstract: The effect of STA-MCA bypass on the prevention of recurrent hemorrhage or an ischemic event in patients with hemorrhagic moyamoya disease has been statistically confirmed in this study.

Cited by 163 publications

References 28 publications

Clinical features and long-term outcomes of moyamoya disease: a single-center experience with 528 cases in China

Clinical features and long-term outcomes of moyamoya disease: a single-center experience with 528 cases in China

“Brush Sign” on Susceptibility-Weighted MR Imaging Indicates the Severity of Moyamoya Disease

Pediatric moyamoya disease presenting with intracerebral hemorrhage—Report of three cases and review of the literature

Contact Info

Product

Resources

About