Effectiveness of Ipsilateral Stroke Prevention Between Conservative Management and Indirect Revascularization for Moyamoya Disease in a North American Cohort

Jose L. Porras, Wuyang Yang, Risheng Xu, Tomas Garzon-Muvdi, Justin M. Caplan, Geoffrey P. Colby, Alexander L. Coon, Edward S. Ahn, Rafael J. Tamargo, Judy Huang

Research output: Contribution to journalArticle

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Abstract

Background: Few reports have compared surgical intervention with conservative treatment for moyamoya disease (MMD) in non-Asian cohorts. This study describes the effectiveness of follow-up stroke prevention by indirect revascularization relative to conservative management in a Northeast United States study population. Method: We retrospectively reviewed records of patients with MMD at our institution from 1990 to 2014. Baseline characteristics and follow-up results including subsequent ipsilateral strokes were collected, and compared between an indirect revascularization group and a conservatively treated group on a per-hemisphere basis. Results: A total of 94 patients with 184 hemispheres were included. The average age was 23.9 ± 18.1 years, with 76.6% (n = 141) being female. Racial distribution comprised white (n = 75, 40.8%), African-American (n = 57, 31.0%), Asian (n = 30, 16.3%), and other (n = 22, 12.0%). Eighty-three hemispheres (45.1%) presented with ipsilateral stroke and 54 (29.3%) with ipsilateral TIA. Management strategies included either conservative management (51.1%) or indirect bypass (48.9%). Patients who were male (P < 0.001), on baseline antiplatelets (P = 0.043), or with speech disturbance (P = 0.002) were more likely to receive indirect revascularization. Patients with headache history were more likely to be treated conservatively (P = 0.046). History of ipsilateral stroke was borderline associated with indirect bypass (P = 0.058). During a follow-up period of 6.37 ± 5.81 years, the annual risk of stroke for indirect revascularization group was 0.93% and 2.70% for the conservative group. Multivariate analysis found that increasing age (P = 0.029), posterior cerebral artery involvement (P = 0.040), and conservative treatment (P = 0.048) were associated with follow-up stroke. Conclusion: Our results suggests that indirect revascularization provides symptom relief and lower risk of stroke during follow-up compared with conservative management. Indirect revascularization should be considered for symptomatic MMD patients with a low surgical risk profile in a similar patient population.

Original languageEnglish (US)
Pages (from-to)e928-e936
JournalWorld Neurosurgery
Volume110
DOIs
StatePublished - Feb 2018
Externally publishedYes

Fingerprint

Moyamoya Disease
Stroke
Posterior Cerebral Artery
Conservative Treatment
African Americans
Population
Headache
Multivariate Analysis

Keywords

  • Conservative management
  • Indirect revascularization
  • Moyamoya disease
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Effectiveness of Ipsilateral Stroke Prevention Between Conservative Management and Indirect Revascularization for Moyamoya Disease in a North American Cohort. / Porras, Jose L.; Yang, Wuyang; Xu, Risheng; Garzon-Muvdi, Tomas; Caplan, Justin M.; Colby, Geoffrey P.; Coon, Alexander L.; Ahn, Edward S.; Tamargo, Rafael J.; Huang, Judy.

In: World Neurosurgery, Vol. 110, 02.2018, p. e928-e936.

Research output: Contribution to journalArticle

Porras, Jose L. ; Yang, Wuyang ; Xu, Risheng ; Garzon-Muvdi, Tomas ; Caplan, Justin M. ; Colby, Geoffrey P. ; Coon, Alexander L. ; Ahn, Edward S. ; Tamargo, Rafael J. ; Huang, Judy. / Effectiveness of Ipsilateral Stroke Prevention Between Conservative Management and Indirect Revascularization for Moyamoya Disease in a North American Cohort. In: World Neurosurgery. 2018 ; Vol. 110. pp. e928-e936.
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abstract = "Background: Few reports have compared surgical intervention with conservative treatment for moyamoya disease (MMD) in non-Asian cohorts. This study describes the effectiveness of follow-up stroke prevention by indirect revascularization relative to conservative management in a Northeast United States study population. Method: We retrospectively reviewed records of patients with MMD at our institution from 1990 to 2014. Baseline characteristics and follow-up results including subsequent ipsilateral strokes were collected, and compared between an indirect revascularization group and a conservatively treated group on a per-hemisphere basis. Results: A total of 94 patients with 184 hemispheres were included. The average age was 23.9 ± 18.1 years, with 76.6{\%} (n = 141) being female. Racial distribution comprised white (n = 75, 40.8{\%}), African-American (n = 57, 31.0{\%}), Asian (n = 30, 16.3{\%}), and other (n = 22, 12.0{\%}). Eighty-three hemispheres (45.1{\%}) presented with ipsilateral stroke and 54 (29.3{\%}) with ipsilateral TIA. Management strategies included either conservative management (51.1{\%}) or indirect bypass (48.9{\%}). Patients who were male (P < 0.001), on baseline antiplatelets (P = 0.043), or with speech disturbance (P = 0.002) were more likely to receive indirect revascularization. Patients with headache history were more likely to be treated conservatively (P = 0.046). History of ipsilateral stroke was borderline associated with indirect bypass (P = 0.058). During a follow-up period of 6.37 ± 5.81 years, the annual risk of stroke for indirect revascularization group was 0.93{\%} and 2.70{\%} for the conservative group. Multivariate analysis found that increasing age (P = 0.029), posterior cerebral artery involvement (P = 0.040), and conservative treatment (P = 0.048) were associated with follow-up stroke. Conclusion: Our results suggests that indirect revascularization provides symptom relief and lower risk of stroke during follow-up compared with conservative management. Indirect revascularization should be considered for symptomatic MMD patients with a low surgical risk profile in a similar patient population.",
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T1 - Effectiveness of Ipsilateral Stroke Prevention Between Conservative Management and Indirect Revascularization for Moyamoya Disease in a North American Cohort

AU - Porras, Jose L.

AU - Yang, Wuyang

AU - Xu, Risheng

AU - Garzon-Muvdi, Tomas

AU - Caplan, Justin M.

AU - Colby, Geoffrey P.

AU - Coon, Alexander L.

AU - Ahn, Edward S.

AU - Tamargo, Rafael J.

AU - Huang, Judy

PY - 2018/2

Y1 - 2018/2

N2 - Background: Few reports have compared surgical intervention with conservative treatment for moyamoya disease (MMD) in non-Asian cohorts. This study describes the effectiveness of follow-up stroke prevention by indirect revascularization relative to conservative management in a Northeast United States study population. Method: We retrospectively reviewed records of patients with MMD at our institution from 1990 to 2014. Baseline characteristics and follow-up results including subsequent ipsilateral strokes were collected, and compared between an indirect revascularization group and a conservatively treated group on a per-hemisphere basis. Results: A total of 94 patients with 184 hemispheres were included. The average age was 23.9 ± 18.1 years, with 76.6% (n = 141) being female. Racial distribution comprised white (n = 75, 40.8%), African-American (n = 57, 31.0%), Asian (n = 30, 16.3%), and other (n = 22, 12.0%). Eighty-three hemispheres (45.1%) presented with ipsilateral stroke and 54 (29.3%) with ipsilateral TIA. Management strategies included either conservative management (51.1%) or indirect bypass (48.9%). Patients who were male (P < 0.001), on baseline antiplatelets (P = 0.043), or with speech disturbance (P = 0.002) were more likely to receive indirect revascularization. Patients with headache history were more likely to be treated conservatively (P = 0.046). History of ipsilateral stroke was borderline associated with indirect bypass (P = 0.058). During a follow-up period of 6.37 ± 5.81 years, the annual risk of stroke for indirect revascularization group was 0.93% and 2.70% for the conservative group. Multivariate analysis found that increasing age (P = 0.029), posterior cerebral artery involvement (P = 0.040), and conservative treatment (P = 0.048) were associated with follow-up stroke. Conclusion: Our results suggests that indirect revascularization provides symptom relief and lower risk of stroke during follow-up compared with conservative management. Indirect revascularization should be considered for symptomatic MMD patients with a low surgical risk profile in a similar patient population.

AB - Background: Few reports have compared surgical intervention with conservative treatment for moyamoya disease (MMD) in non-Asian cohorts. This study describes the effectiveness of follow-up stroke prevention by indirect revascularization relative to conservative management in a Northeast United States study population. Method: We retrospectively reviewed records of patients with MMD at our institution from 1990 to 2014. Baseline characteristics and follow-up results including subsequent ipsilateral strokes were collected, and compared between an indirect revascularization group and a conservatively treated group on a per-hemisphere basis. Results: A total of 94 patients with 184 hemispheres were included. The average age was 23.9 ± 18.1 years, with 76.6% (n = 141) being female. Racial distribution comprised white (n = 75, 40.8%), African-American (n = 57, 31.0%), Asian (n = 30, 16.3%), and other (n = 22, 12.0%). Eighty-three hemispheres (45.1%) presented with ipsilateral stroke and 54 (29.3%) with ipsilateral TIA. Management strategies included either conservative management (51.1%) or indirect bypass (48.9%). Patients who were male (P < 0.001), on baseline antiplatelets (P = 0.043), or with speech disturbance (P = 0.002) were more likely to receive indirect revascularization. Patients with headache history were more likely to be treated conservatively (P = 0.046). History of ipsilateral stroke was borderline associated with indirect bypass (P = 0.058). During a follow-up period of 6.37 ± 5.81 years, the annual risk of stroke for indirect revascularization group was 0.93% and 2.70% for the conservative group. Multivariate analysis found that increasing age (P = 0.029), posterior cerebral artery involvement (P = 0.040), and conservative treatment (P = 0.048) were associated with follow-up stroke. Conclusion: Our results suggests that indirect revascularization provides symptom relief and lower risk of stroke during follow-up compared with conservative management. Indirect revascularization should be considered for symptomatic MMD patients with a low surgical risk profile in a similar patient population.

KW - Conservative management

KW - Indirect revascularization

KW - Moyamoya disease

KW - Stroke

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