Postdoctoral Research Fellow Thomas Jefferson University Hospital Philadelphia, Pennsylvania, United States
Introduction: Moyamoya is a chronic occlusive cerebrovascular disease of unknown etiology causing neovascularization of the lenticulostriate collaterals at the base of the brain. Although revascularization surgery is the most effective treatment for moyamoya, there is still no consensus on the best surgical treatment modality as different studies provide different outcomes.In this large case series, we compare the outcomes of direct (DR) and indirect revascularization (IR) and compare our results to the literature in order to reflect on the best revascularization modality for moyamoya.
Methods: We conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines of moyamoya affected hemispheres treated with direct and indirect revascularization surgeries across 13 academic institutions predominantly in North America. All patients who underwent surgical revascularization of their moyamoya-affected hemispheres were included in the study. The primary outcome of the study was the rate of symptomatic strokes.
Results: The rates of symptomatic strokes across 515 disease-affected hemispheres were comparable between the two cohorts (11.6% in the DR cohort vs 9.6% in the IR cohort, OR=1.238 [0.651-2.354], p=0.514). The rate of total peri-operative strokes was slightly higher in the DR cohort (6.1% for DR vs 2.0% for IR, OR=3.129 [0.991-9.875], p= 0.052). The rate of total follow-up strokes was slightly higher in the IR cohort (8.1% vs 6.6%, OR=0.799 [0.374-1.709] p=0.563).
Conclusion : Since both modalities showed comparable rates of overall total strokes, both modalities of revascularization can be performed depending on the patient’s risk assessment.
