Long-Term Outcomes After Combined Revascularization Surgery in Adult Moyamoya Disease

Cho, Won Sang; Kim, Jeong Eun; Kim, Chang Hyeun; Ban, Seung Pil; Kang, Hyun Seung; Son, Young Hoon; Bang, Jae Seung; Sohn, Chul Ho; Paeng, Jin Chul; Oh, Chang Wan

doi:10.1161/strokeaha.114.005624

Cited by 151 publications

(98 citation statements)

References 31 publications

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“…2,5,8,10,12,17,22 Because of the low prevalence of MMD, most studies concerned with surgical outcomes have been conducted with relatively small sample sizes. As far as we know, the largest cohort study, involving 802 patients, was conducted in China.…”

Section: Discussionmentioning

confidence: 99%

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

Kim

Kwon

et al. 2016

JNS

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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...

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Section: Discussionmentioning

confidence: 99%

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

Kim

Kwon

et al. 2016

JNS

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“…29–31 Furthermore, it has been reported that sarcopenia is positively associated with a loss of bone mineral density and osteoporosis, leading to an increased fracture risk in older adults. 32 These adverse relationships between obesity and dynapenia/sarcopenia/osteoporosis increase as individuals age. 33,34 Because previous studies have primarily focused on the relationship between obesity and falls in older adults, our data move the field forward by identifying a relationship between falls and obesity in all adult groups, not exclusively older adults.…”

Section: Discussionmentioning

confidence: 99%

Association Between Obesity and Falls Among Korean Adults

Kim

Sim

et al. 2016

Medicine

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The objective of this study was to evaluate the association between falls and obesity using Asian body mass index (BMI) classifications. Using the data from the Korean community health survey in 2011, a total of 229,226 participants ranging from 19 to 106 years old were included in this study. The BMI groups were classified as underweight (<18.5), healthy (18.5 ≤ BMI < 23), overweight (23 ≤ BMI <25), and obese (≥25) using Asian BMI classifications. The associations between BMI groups and falls (≥1 time or ≥2 times per year) were analyzed using multiple logistic regression analyses with complex sampling. A subgroup analysis was conducted according to age (19–40, 41–60, and ≥61 years) and the location of the fall (indoor and outdoor). Physical activity, household income, education level, alcohol consumption, smoking, stress level, and medical comorbidities were adjusted as confounders. In total, 16.8% and 6.1% of the participants experienced falls ≥1 time and ≥2 times per year, respectively. Compared to the healthy weight group, the other BMI groups showed a significant U-shaped relationship with falls ≥1 time (AOR underweight = 1.12, 95% CI [confidence interval] = 1.05–1.19; AOR obese = 1.06, 95% CI = 1.02–1.10, P < 0.001) and ≥2 times (AOR underweight = 1.14, 95% CI = 1.04–1.26; AOR obese = 1.04, 95% CI = 0.99–1.10, P < 0.001). Obese status was significantly associated with falls (≥1 fall per year) in all age groups, whereas being underweight was significantly associated with falls in the 19 to 40 year age group only. In conclusion, both underweight and obese statuses were significantly associated with falls in this adult Korean population. However, the relationship between BMI group and falls varied according to age and the location of the falls.

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“…Rates by procedure type were 3.2% (n=11) of 341 patients undergoing direct bypass (13 studies 6,7,15,16,[18][19][20][21][22][23][24][25][26] [35][36][37][38][39][40]43 ).…”

Section: Perioperative Ischemiamentioning

confidence: 99%

Perioperative Complications and Long-Term Outcomes After Bypasses in Adults with Moyamoya Disease: A Systematic Review and Meta-Analysis

Sun

Wilson²,

Ozpinar

et al. 2016

World Neurosurgery

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Long-Term Outcomes After Combined Revascularization Surgery in Adult Moyamoya Disease

Cited by 151 publications

References 31 publications

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

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

Association Between Obesity and Falls Among Korean Adults

Perioperative Complications and Long-Term Outcomes After Bypasses in Adults with Moyamoya Disease: A Systematic Review and Meta-Analysis

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