Outcomes of Medical Management Alone for Adult Patients with Cerebral Misery Perfusion Due to Ischemic Moyamoya Disease

Ogasawara, Kuniaki; Uchida, Shun; Akamatsu, Yosuke; Chida, Kohei; Kobayashi, Masatoshi; Yoshida, Kenji; Fujiwara, Shunrou; Terasaki, Kazunori; Kubo, Yoshitaka

doi:10.1016/j.jstrokecerebrovasdis.2022.106588

Cited by 6 publications

(2 citation statements)

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“…It is likely that the dominant bypass flow reduces the burden on moyamoya vessels, which results in the relief of hemodynamic stress. Adults with ischemic MMD receiving medical management alone usually experience poor outcomes, with recurrent annual stroke rates of 20% to 50% . In reports examining adults with MMD treated with indirect bypass, 0 to 14.3% of patients experienced a postoperative stroke each year, and the weighted mean annual rate of stroke was 5.6%.…”

Section: Discussionmentioning

confidence: 99%

“…Adults with ischemic MMD receiving medical management alone usually experience poor outcomes, with recurrent annual stroke rates of 20% to 50%. [29][30][31] In reports examining adults with MMD treated with indirect bypass, 2,32-36 0 to 14.3% of patients experienced a postoperative stroke each year, and the weighted mean annual rate of stroke was 5.6%. In the present study, bypass surgery was associated with a reduced risk of death and IS, and IS risk remained after adjustment, which is consistent with previous reports.…”

Section: Management Of Ischemic and Hemorrhagic MMD In Adultsmentioning

confidence: 99%

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Outcomes of Bypass Surgery in Adult Moyamoya Disease by Onset Type

Lim,

Lee,

Song

2024

JAMA Netw Open

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ImportanceMoyamoya disease (MMD) is a rare chronic cerebrovascular disease, and the outcomes of bypass management in adult patients remain controversial.ObjectiveTo categorize adult MMD based on asymptomatic, ischemic, and hemorrhagic onset and compare the outcomes (death, hemorrhagic stroke [HS], and ischemic stroke [IS]) of bypass surgery (direct or indirect) with those of conservative management.Design, Setting, and ParticipantsThis retrospective, nationwide, population-based longitudinal cohort study used Korean National Health Insurance Research data to identify adults (aged ≥15 years) with MMD who were diagnosed between January 1, 2008, and December 31, 2020, and followed up until December 31, 2021 (median follow-up, 5.74 [IQR, 2.95-9.42] years). A total of 19 700 participants (3194 with hemorrhagic, 517 with ischemic, and 15 989 with asymptomatic MMD) were included. Data were analyzed from January 2 to April 1, 2023.ExposuresBypass surgery and conservative management.Main Outcomes and MeasuresDeath constituted the primary outcome; secondary outcomes consisted of HS or IS. Kaplan-Meier survival curve and Cox proportional hazards regression analysis were applied. The propensity score–matching and stratified analyses were performed to control covariate effects.ResultsA total of 19 700 patients (mean [SD] age, 45.43 [14.98] years; 12 766 [64.8%] female) were included. Compared with conservative management, bypass was associated with a reduced risk of death (adjusted hazard ratio [AHR], 0.50 [95% CI, 0.41-0.61]; P &lt; .001) and HS (AHR, 0.36 [0.30-0.40]; P &lt; .001) in hemorrhagic MMD; reduced risk of IS (AHR, 0.55 [95% CI, 0.37-0.81]; P = .002) in ischemic MMD; and reduced risk of death (AHR, 0.74 [95% CI, 0.66-0.84]; P &lt; .001) in asymptomatic MMD. However, bypass was associated with an increased risk of HS (AHR, 1.76 [95% CI, 1.56-2.00]; P &lt; .001) in asymptomatic MMD. Both direct and indirect bypass demonstrated similar effects in hemorrhagic and asymptomatic MMD, except only direct bypass was associated with a reduced risk of IS (AHR, 0.52 [95% CI, 0.33- 0.83]; P = .01) in ischemic MMD. After stratification, bypass was associated with a reduced risk of death in patients younger than 55 years with ischemic (AHR, 0.34 [95% CI, 0.13- 0.88]; P = .03) and asymptomatic (AHR, 0.69 [95% CI, 0.60-0.79]; P &lt; .001) MMD, but an increased risk of HS in patients 55 years or older with ischemic MMD (AHR, 2.13 [95% CI, 1.1-4.16]; P = .03).Conclusions and RelevanceThe findings of this cohort study of bypass outcomes for patients with MMD emphasize the importance of tailoring management strategies in adult patients based on onset types.

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Section: Discussionmentioning

confidence: 99%

Section: Management Of Ischemic and Hemorrhagic MMD In Adultsmentioning

confidence: 99%