Bradley A Gross1, Rose Du. 1. Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Abstract
BACKGROUND: Although cerebral revascularization is an accepted treatment for moyamoya, the precise impact of direct or indirect bypass methods on subsequent event rates is infrequently addressed in adult cohorts. METHODS: We reviewed 45 consecutive adults with 69 hemispheres affected by moyamoya. We evaluated stroke and hemorrhage rates prior to and following revascularization. RESULTS: Direct revascularization was performed for 35 hemispheres (51 %) in 29 patients (64 %). The annual stroke, hemorrhage and overall event rates in this cohort diminished from 8.9 %, 2.0 %, and 11 % per hemisphere-year to 4.5 %, 0 %, and 4.5 % per hemisphere-year after treatment, respectively (p = 0.06). Excluding perioperative events, no events occurred over 41.1 hemisphere-years of follow-up (p = 0.0017). After a mean clinical follow-up period of 1.3 years, 72 % of patients were improved, 24 % the same, and 3 % worse in this cohort. Indirect revascularization was performed for 18 hemispheres (26 %) in 13 patients (29 %). The annual stroke, hemorrhage and overall event rates were 13 %, 0 %, and 13 % per hemisphere-year prior to treatment, and 6.8 %, 4.5 %, and 11 % per hemisphere-year after treatment, respectively (p = 0.67). Excluding perioperative events, the overall annual event rate was 7.1 % (p = 0.69). After a mean clinical follow-up of 2.7 years, 46 % of patients were improved, 38 % were the same and 15 % were worse. CONCLUSION: Direct revascularization is the optimal choice to prevent subsequent events in adult patients with moyamoya. A favorable impact of indirect revascularization was less clear in this cohort, and should be reserved for patients with an inadequate donor vessel.
BACKGROUND: Although cerebral revascularization is an accepted treatment for moyamoya, the precise impact of direct or indirect bypass methods on subsequent event rates is infrequently addressed in adult cohorts. METHODS: We reviewed 45 consecutive adults with 69 hemispheres affected by moyamoya. We evaluated stroke and hemorrhage rates prior to and following revascularization. RESULTS: Direct revascularization was performed for 35 hemispheres (51 %) in 29 patients (64 %). The annual stroke, hemorrhage and overall event rates in this cohort diminished from 8.9 %, 2.0 %, and 11 % per hemisphere-year to 4.5 %, 0 %, and 4.5 % per hemisphere-year after treatment, respectively (p = 0.06). Excluding perioperative events, no events occurred over 41.1 hemisphere-years of follow-up (p = 0.0017). After a mean clinical follow-up period of 1.3 years, 72 % of patients were improved, 24 % the same, and 3 % worse in this cohort. Indirect revascularization was performed for 18 hemispheres (26 %) in 13 patients (29 %). The annual stroke, hemorrhage and overall event rates were 13 %, 0 %, and 13 % per hemisphere-year prior to treatment, and 6.8 %, 4.5 %, and 11 % per hemisphere-year after treatment, respectively (p = 0.67). Excluding perioperative events, the overall annual event rate was 7.1 % (p = 0.69). After a mean clinical follow-up of 2.7 years, 46 % of patients were improved, 38 % were the same and 15 % were worse. CONCLUSION: Direct revascularization is the optimal choice to prevent subsequent events in adult patients with moyamoya. A favorable impact of indirect revascularization was less clear in this cohort, and should be reserved for patients with an inadequate donor vessel.
Authors: Ronan J Doherty; John Caird; Darach Crimmins; Peter Kelly; Sean Murphy; Christopher McGuigan; Niall Tubridy; Mary D King; Bryan Lynch; David Webb; Desmond O'Neill; Dominick J H McCabe; Peter Boers; Mary O'Regan; Joan Moroney; David J Williams; Simon Cronin; Mohsen Javadpour Journal: Ir J Med Sci Date: 2020-06-19 Impact factor: 1.568