The Efficacy of Surgical Treatment for the Secondary Prevention of Stroke in Symptomatic Moyamoya Disease

Abstract

The treatment of moyamoya disease (MMD) is controversial and often depends on the doctor's experience. In addition, the choice of surgical procedure to treat MMD can differ in many ways. In this study, we performed a meta-analysis to determine whether surgical treatment of MMD is superior to conservative treatment and to provide evidence for the selection of an appropriate surgical treatment.The human case–control studies regarding the association of MMD treatment were systematically identified through online databases (PubMed, Web of Science, Elsevier Science Direct, and Springer Link). Inclusion and exclusion criteria were defined for the eligible studies. The fixed-effects model was performed when homogeneity was indicated. Alternatively, the random-effects model was utilized.This meta-analysis included 16 studies. Surgical treatment significantly reduced the risk of stroke (odds ratio (OR) of 0.17, 95% confidence interval (CI), 0.12–0.26, P < 0.01). A subgroup analysis showed that surgical treatment was more beneficial to hemorrhagic MMD (OR of 0.23, 95% CI, 0.15–0.38, P < 0.01), but there was no significant difference between surgical treatment and conservative treatment on ischemic MMD treatment (OR of 0.45, 95% CI, 0.15–1.29, P = 0.14). Further analysis indicated that compared to direct bypass surgery, indirect bypass surgery had a lower efficacy on secondary stroke risk reduction (OR of 1.79, 95% CI, 1.14–2.82, P = 0.01), while no significant difference was detected for perioperative complications.Surgery is an effective treatment for symptomatic MMD patients, and direct bypass surgery may bring more benefits for these patients.

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

“…39 A recent meta-analysis investigating surgical outcomes of symptomatic MMD patients showed that perioperative complications were more frequent in the direct bypass group (30.2%) than in the indirect bypass group (18.8%), but the difference did not reach statistical significance (p = 0.176). 35 In our study, we did not see a significant difference in the overall postoperative complication rate when comparing the different surgical modalities.…”

Quantitative Angiographic Hemodynamic Evaluation After Revascularization Surgery for Moyamoya Disease

“…At present, accumulating evidence indicates that surgical revascularization may be the most effective treatment paradigm for ischemic MMD [37][38][39]. Our previous studies compared the long-term postoperative neurofunctional outcomes of different revascularization strategies and suggested that direct bypass was more effective in preventing recurrent ischemic strokes than indirect bypass for ischemic MMD, although neurological function outcomes were similar [40][41][42].…”

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

“…Recently, two meta-analysis of the MMD treatment outcome have been published5154). Qian et al51) reported that bypass surgery significantly reduced future stroke than conservative treatment (OR 0.17; 95% CI : 0.12–0.26, p <0.01).…”

“…Qian et al51) reported that bypass surgery significantly reduced future stroke than conservative treatment (OR 0.17; 95% CI : 0.12–0.26, p <0.01). But they did not find surgical benefit for MMD patients with ischemic presentation (OR, 0.45; 95% CI : 0.15–1.29, p =0.14).…”

“…Sun et al54) suggested that direct bypass provide better risk reduction of long-term ischemia than indirect (OR, 0.51; 95% CI : 0.33–0.77) or combined bypass (OR, 0.47; 95% CI : 0.31–0.72) in adult MMD. However, heterogeneous population (mixed pediatric and adult MMD patients)51) and a potentially confounding factors (mixed symptomatic and asymptomatic patients)54) were concerns to interpret the results. In this meta-analysis, we only included for Koran MMD patients.…”