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Cerebrovascular events after surgery versus conservative therapy for moyamoya disease: a meta-analysis

Anke Wouters1,2,3, Ide Smets4,5, Wim Van den Noortgate6,7

  • 1Department of Neurosciences, Experimental Neurology, KU Leuven, University of Leuven, Leuven, Belgium. anke.wouters@uzleuven.be.

Acta Neurologica Belgica
|June 20, 2019
PubMed

Insights

Neurosurgical intervention for moyamoya disease (MMD) significantly reduces stroke risk, particularly for hemorrhagic MMD. Surgery also lowers mortality, but shows no significant effect on ischemic stroke risk in MMD patients.

Area of Science:

  • Neurosurgery
  • Neurology
  • Vascular Neurology

Background:

  • Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of the internal carotid arteries.
  • Cerebrovascular events, including stroke and hemorrhage, are significant risks for MMD patients.
  • The efficacy of neurosurgical intervention versus conservative therapy in managing MMD remains a critical clinical question.

Purpose of the Study:

  • To evaluate the effect of neurosurgical intervention on cerebrovascular event risk in moyamoya disease patients.
  • To compare outcomes between surgical treatment and conservative therapy for MMD.
  • To analyze the impact of surgery on stroke subtypes (hemorrhagic and ischemic) and mortality.

Main Methods:

  • A systematic review and random-effects meta-analysis of studies investigating neurosurgical intervention versus conservative therapy in MMD.
  • Inclusion criteria: studies with ≥10 MMD patients per group and ≥1-year follow-up.
  • Primary outcome: all strokes; secondary outcomes: mortality, hemorrhagic stroke, and ischemic stroke.

Main Results:

  • Neurosurgical intervention was associated with a reduced rate of all strokes (14.1% vs. 30.0%; pooled OR 0.38).
  • Hemorrhagic stroke rates were significantly lower in surgically treated patients (4.6% vs. 18.6%; pooled OR 0.27).
  • Mortality was also reduced with surgery (0.6% vs. 2.9%; pooled OR 0.32), while ischemic stroke risk showed no significant difference (pooled OR 0.71).

Conclusions:

  • Neurosurgical intervention in moyamoya disease is associated with a decreased risk of overall stroke, most notably in patients with hemorrhagic MMD.
  • Surgical treatment significantly reduces the incidence of hemorrhagic stroke and mortality in MMD patients.
  • The study did not find a significant association between surgical treatment and a reduced risk of ischemic stroke in MMD.
Keywords:
Meta-analysisMoyamoyaMoyamoya diseaseOutcomeSurgical interventionTreatment

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