Stroke prevention by direct revascularization for patients with adult-onset moyamoya disease presenting with ischemia

Abstract

M oyaMoya disease (MMD) is a progressive disease that causes recurrent stroke through progressive stenosis of the terminal internal carotid arteries. 19 However, the pathogenesis of MMD has not yet been well characterized. Nevertheless, revascularization surgery for symptomatic MMD is considered standard treatment for preventing further stroke, as it results in an augmentation of cerebral blood flow and stabilizes collateral vessels. 9,24Due to the progressive nature of MMD, investigations into its natural history have been limited in asymptomatic patients with a relatively stable hemodynamic status. While the annual stroke rate of nonsurgically treated adult patients with MMD has been reported to be 3.2%-13.3%, 3,4,11,13,15,18,23 the incidence of stroke after direct or combined revascularization surgery appears to be lower. Several retrospective cohort studies have investigated this abbreviatioNs ARR = absolute risk reduction; AS = any kind of stroke; DSA = digital subtraction angiography; D-SPECT = SPECT with acetazolamide (Diamox) challenge; HS = hemorrhagic stroke; IS = ischemic stroke; MMD = moyamoya disease; mRS = modified Rankin Scale; NNT = number needed to treat; OA = occipital artery; RRR = relative risk reduction; SPECT = single photon emission tomography; STA = superficial temporal artery; TIA = transient ischemic attack. » This article has been updated from its originally published versionto correct the footnotes in obJective Moyamoya disease (MMD) is a progressive disease that can cause recurrent stroke. The authors undertook this retrospective case-control study with a large sample size in an attempt to assess the efficacy of direct or combined revascularization surgery for ischemia in adults with MMD. methods The authors investigated cases involving patients with moyamoya disease presenting with ischemia who visited Seoul National University Bundang Hospital and Seoul National University Hospital between 2000 and 2014. Among 441 eligible patients, 301 underwent revascularization surgery and 140 were treated conservatively. Variables evaluated included age at diagnosis, sex, surgical record, Suzuki stage, and occurrence of stroke. Patients were stratified into 2 groups based on whether or not they had undergone revascularization surgery. Actuarial 1-, 5-, and 10-year stroke rates were calculated using the life table method. Risk factor analysis for 5-year stroke occurrence was conducted with multivariate regression. results Of the 441 patients, 301 had been surgically treated (revascularization group) and 140 had not (control group). The mean follow-up durations were 45 and 77 months, respectively. The actuarial 10-year cumulative incidence rate for any kind of stroke was significantly lower in the revascularization group (9.4%) than in the control group (19.6%) (p = 0.041); the relative risk reduction (RRR) was also superior (52.0%) in the revascularization group, and the number needed to treat was 10. The 10-year rate of ischemic stroke was greater (13.3%) in the control group than in the revas...

Genotype-Phenotype Correlation in Long-Term Cohort of Japanese Patients with Moyamoya Disease

“…1 ticular, recurrent hemorrhage was observed in 5 patients. In several past large studies, the incidence of recurrent stroke after revascularization was reported to be approximately 5-20% (annual risk: 0.4-6.7%) [11][12][13][14][15][16]. It is difficult to directly compare these incidences because the included patients' characteristics, follow-up rate, or management made a difference to the incidence of recurrent stroke in our study.…”

Risk factors for postoperative stroke in adults patients with moyamoya disease: a systematic review with meta-analysis

“…There were 8 studies [5][6][7][8][9][10][11][12] encompassing 1649 patients who underwent surgery with MMD were selected for analysis. The detailed study selection progress was shown in Figure 1.…”

“…The main characteristics of included studies are summarized in Table 1. The included studies were consisted of 3 prospective studies [6,11,12] and 5 retrospective studies [5,[7][8][9][10].…”

“…Previous studies have attempted to determine risk factors that would predict postoperative complications [5][6][7][8][9][10][11][12]. To identify the clinical factors can be more useful in preventing postoperative complications.…”

A Recent Update of Clinical and Research Topics Concerning Adult Moyamoya Disease

“…1. After records screening and deciding eligibility, 3 articles were included finally (Table 1)83640). A total of 627 patients from 3 studies were included to assess surgical efficacy in preventing recurrent stroke compared to conservative treatment (Fig.…”