Surgical Outcomes and Predictors of Stroke in a North American White and African American Moyamoya Population

Mallory, Grant W.; Bower, Regina S.; Nwojo, Macaulay; Taussky, Philipp; Wetjen, Nicholas M.; Varzoni, Thais; Hanel, Ricardó A.; Meyer, Fredric B.

doi:10.1227/neu.0000000000000162

Cited by 25 publications

(16 citation statements)

References 61 publications

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“…Although many researchers have reported the benefits of bypass surgery in adult ischemic MMD, 15,35 no randomized controlled trial has been performed in this population. In contrast to previous studies, 5,14,15,28,35 we demonstrated no preventive effects for stroke throughout the postoperative period in adult patients with ischemic MMD (Fig. 2B and Table 5).…”

Section: Discussioncontrasting

confidence: 99%

“…Although many studies have reported the effectiveness of bypass surgery in adult MMD, 4,9,16,17,25,31,34,35 only 1 randomized clinical trial showed a marginally preventive effect of direct bypass on subsequent bleeding in hemorrhagic MMD in adults. 29 Some investigators have reported favorable results of bypass surgery on secondary stroke prevention in adult MMD, 1,26,28,35 but others found no significant differences in secondary stroke prevention between surgical revascularization and medical management. 9 In this study, bypass surgery to prevent stroke showed different results for ischemic and hemorrhagic MMD (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Bypass surgery versus medical treatment for symptomatic moyamoya disease in adults

Jang

Lee

Rha

et al. 2017

Journal of Neurosurgery

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OBJECTIVE In this study the authors evaluated whether extracranial-intracranial bypass surgery can prevent stroke occurrence and decrease mortality in adult patients with symptomatic moyamoya disease (MMD). METHODS The medical records of 249 consecutive adult patients with symptomatic MMD that was confirmed by digital subtraction angiography between 2002 and 2011 at 8 institutions were retrospectively reviewed. The study outcomes of stroke recurrence as a primary event and death during the 6-year follow-up and perioperative complications within 30 days as secondary events were compared between the bypass and medical treatment groups. RESULTS The bypass group comprised 158 (63.5%) patients, and the medical treatment group comprised 91 (36.5%) patients. For 249 adult patients with MMD, bypass surgery showed an HR of 0.48 (95% CI 0.27-0.86, p = 0.014) for stroke recurrence calculated by Cox regression analysis. However, for the 153 patients with ischemic MMD, the HR of bypass surgery for stroke recurrence was 1.07 (95% CI 0.43-2.66, p = 0.887). For the 96 patients with hemorrhagic MMD, the multivariable adjusted HR of bypass surgery for stroke recurrence was 0.18 (95% CI 0.06-0.49, p = 0.001). For the treatment modality, indirect bypass and direct bypass (or combined bypass) did not show any significant difference for stroke recurrence, perioperative stroke, or mortality (log rank; p = 0.524, p = 0.828, and p = 0.616, respectively). CONCLUSIONS During the treatment of symptomatic MMD in adults, bypass surgery reduces stroke recurrence for the hemorrhagic type, but it does not do so for the ischemic type. The best choice of bypass methods in adult patients with MMD is uncertain. In adult ischemic MMD, a prospective randomized study to evaluate the effectiveness and safety of bypass surgery to prevent recurrent stroke is necessary.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bypass surgery versus medical treatment for symptomatic moyamoya disease in adults

Jang

Lee

Rha

et al. 2017

Journal of Neurosurgery

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“…The previously reported rate of postoperative ischemia in adult MMD patients varies from 1.5% to 11.4% for direct/combined bypass 12,18,20 and from 3.0% to 11.1% for indirect bypass. 21,26,30 A recent meta-analysis showed that perioperative ischemia (cerebral ischemic event within 30 days of bypass) rates by procedure type were 4.8% for indirect bypass, 3.2% for direct tive TIAs has also been suggested as an important indicator of perioperative ischemic complication risk. 18 Other factors, such as female sex, 22 hypotension, hypocapnia, perioperative hypovolemia, brain atrophy, 25,37 presence of underlying disease, 12 and disease involvement in the PCA, 20 have been previously reported to be associated with increase of postoperative ischemic complications in MMD patients.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for and outcomes of postoperative complications in adult patients with moyamoya disease

Zhao

Deng

Zhang

et al. 2019

Journal of Neurosurgery

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OBJECTIVE The risk factors and clinical significance of postoperative complications in moyamoya disease are still unclear. The aim of this study was to investigate the predictors of postoperative complications in moyamoya disease and examine the impact of complications on outcomes. METHODS The authors reviewed consecutive cases involving adult moyamoya disease patients who underwent indirect, direct, or combined bypass surgery in their hospital between 2009 and 2015. Preoperative clinical characteristics and radiographic features were recorded. Postoperative complications within 14 days after surgery were examined. Multivariate logistic regression analyses were performed to identify the risk factors for either postoperative ischemia or postoperative cerebral hyperperfusion. Outcome data, including recurrent strokes and neurological status (modified Rankin Scale [mRS]) during follow-up, were collected. Outcomes were compared between patients who had complications with those without complications, using propensity-score analysis to account for between-group differences in baseline characteristics. RESULTS A total of 500 patients (610 hemispheres) were included in this study. Postoperative complications were observed in 74 operations (12.1%), including new postoperative ischemia in 30 cases (4.9%), hyperperfusion in 27 (4.4%), impaired wound healing in 12 (2.0%), and subdural effusion in 6 (1.0%). The complication rates for different surgery types were as follows: 12.6% (n = 25) for indirect bypass, 12.7% (n = 37) for direct bypass, and 10.0% (n = 12) for combined bypass (p = 0.726). Postoperative ischemic complications occurred in 30 hemispheres (4.9%) in 30 different patients, and postoperative symptomatic hyperperfusion occurred after 27 procedures (4.4%). Advanced Suzuki stage (OR 1.669, 95% CI 1.059-2.632, p = 0.027) and preoperative ischemic presentation (OR 5.845, 95% CI 1.654-20.653, p = 0.006) were significantly associated with postoperative ischemia. Preoperative ischemic presentation (OR 5.73, 95% CI 1.27-25.88, p = 0.023) and admission modified Rankin Scale (mRS) score (OR 1.81, 95% CI 1.06-3.10, p = 0.031) were significantly associated with symptomatic postoperative cerebral hyperperfusion syndrome (CHS). Compared with patients without postoperative complications, patients who experienced any postoperative complications had longer hospital stays and worse mRS scores at discharge (both p < 0.0001). At the final follow-up, no significant differences in functional disability (mRS score 3-6, 11.9% vs 4.5%, p = 0.116) and future stroke events (p = 0.513) between the 2 groups were detected. CONCLUSIONS Advanced Suzuki stage and preoperative ischemic presentation were independent risk factors for postoperative ischemia; the mRS score on admission and preoperative ischemic presentation were independently associated with postoperative CHS. Although patients with postoperative complications had worse neurological status at discharge, postoperative complications had no associations with future stroke events or fun...

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“…It was recently reported that increased thyroid function and elevated thyroid autoantibodies are associated with Moyamoya disease, and thus the monitoring of thyroid function and thyroid autoantibodies in patients with Moyamoya disease was suggested. 15,16 Three of the mothers in the present study had hyperthyroidism, but all of them showed normal thyroid function during pregnancy and post-partum.…”

Section: Discussionmentioning

confidence: 60%

Vaginal delivery in pregnancy with Moyamoya disease: Experience at a single institute

Tanaka

Katsuragi

Tanaka

et al. 2014

J of Obstet and Gynaecol

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Surgical Outcomes and Predictors of Stroke in a North American White and African American Moyamoya Population

Cited by 25 publications

References 61 publications

Bypass surgery versus medical treatment for symptomatic moyamoya disease in adults

Bypass surgery versus medical treatment for symptomatic moyamoya disease in adults

Risk factors for and outcomes of postoperative complications in adult patients with moyamoya disease

Vaginal delivery in pregnancy with Moyamoya disease: Experience at a single institute

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