Indirect revascularization vs. non-surgical treatment for Moyamoya disease and Moyamoya syndrome: A comparative effectiveness study

Abstract

BackgroundThe efficacy of indirect revascularization vs. non-surgical treatment in adults with Moyamoya disease (MMD) and Moyamoya syndrome (MMS) remains controversial.ObjectiveTo compare the clinical outcomes of indirect revascularization and non-surgical treatments in adult patients with MMD and MMS.MethodsWe collected medical records and follow-up results of adult patients with MMD and MMS who received treatment in the China-Japan Union Hospital of Jilin University between January 2019 and December 2021. A Shapiro–Wilk test, independent sample t-test or Mann-Whitney U-test, and Pearson chi-square test were used to compare baseline variables. The propensity-score analysis was used to compare clinical outcomes of patients with MMD and MMS who underwent indirect revascularization and non-surgical treatments. The color-coded digital subtraction angiography (CC-DSA) was used to quantitatively analyzed the preoperative and postoperative (at 6-month follow-up) images of patients in the surgical group.ResultsA total of 144 patients were included in this study, of whom 37 received indirect revascularization treatment and 107 received non-surgical treatment. The average age of the patients was 58.3 ± 13.4 years. Perioperative complications were observed in eight of the operations. During the follow-up period, a total of 35 stroke events occurred, including two cases (5.4%) in the surgery group and 33 cases (30.8%) in the non-surgery group (p < 0.05). The preoperative mean transit time (MTT) of bypass vessel (superficial temporal artery, STA) was 0.26 ± 0.07, and the postoperative MTT of bypass vessel was 3.0 ± 0.25, and there was no statistical difference between the subgroups.ConclusionIndirect revascularization surgery can significantly reduce the recurrent stroke incidence of MMD and MMS patients.

Encephaloduroarteriosynangiosis Procedure: A Treatment Option for Patients With Moyamoya Disease

“…Cerebral angiography is the gold standard for diagnosing MMD; however, this test can be omitted when magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) meet the criteria for diagnosis 4 . The narrowing or blocking of blood vessels can originate at the terminal portion of the internal carotid artery (ICA), at the proximal portions of the anterior cerebral artery (ACA), or in the middle cerebral artery (MCA) 5 . This alteration in the vessels can lead to a reduction in blood flow to the brain, resulting in an increased risk of stroke.…”

“…This alteration in the vessels can lead to a reduction in blood flow to the brain, resulting in an increased risk of stroke. Patients with MMD may present with ischemic or hemorrhagic complications, which have a considerable effect on the treatment options 5 . Although symptoms vary in presentation, they can range from a transient ischemic attack to profound neurological impairments, including cognitive, motor, sensory, and speech deficits and seizures 6 .…”

“…Aside from the traditional risks of surgery (eg, bleeding, infection), patients undergoing revascularization procedures are at risk for cerebral hyperperfusion syndrome, postoperative ischemia, impaired wound healing, and subdural effusion. 5 Cerebral hyperperfusion syndrome occurs when blood vessels are chronically underperfused and dilated. 22 During revascularization, the vasculature improves and perfusion increases, but the vessels are unable to contract appropriately or autoregulate.…”

“…Patients with MMD may present with ischemic or hemorrhagic complications, which have a considerable effect on the treatment options. 5 Although symptoms vary in presentation, they can range from a transient ischemic attack to profound neurological impairments, including cognitive, motor, sensory, and speech deficits and seizures. 6 It is imperative for perioperative nurses to have an understanding of MMD, the multiple approaches to treatment (ie, nonsurgical; direct, indirect, and combination revascularization procedures) and the risks and benefits of each surgical procedure, and the many perioperative considerations when caring for patients with this disease.…”

“…4 The narrowing or blocking of blood vessels can originate at the terminal portion of the internal carotid artery (ICA), at the proximal portions of the anterior cerebral artery (ACA), or in the middle cerebral artery (MCA). 5 This alteration in the vessels can lead to a reduction in blood flow to the brain, resulting in an increased risk of stroke. Patients with MMD may present with ischemic or hemorrhagic complications, which have a considerable effect on the treatment options.…”