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Ipsilateral late stroke after revascularization surgery for patients with Moyamoya disease
Yoshio Araki1, Kinya Yokoyama2, Kenji Uda2
1Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, Japan. y.araki@med.nagoya-u.ac.jp.
Background:
Ipsilateral late stroke events occurring after cerebral revascularization for Moyamoya disease (MMD) and their risk factors have not been fully investigated.
Methods:
We retrospectively analyzed 123 patients with MMD who underwent 212 revascularizations. We investigated preoperative demographic data, surgical procedures, and ipsilateral stroke events occurring more than 1 month after surgery. The effect of revascularization and the residual Moyamoya vessel (MMV) score were examined using magnetic resonance angiography (MRA). Then, predictive factors for postoperative late stroke occurrence were evaluated by logistic regression.
Results:
The mean age was 26 ± 18.4 years (range 1 to 66 years). Ipsilateral late stroke events were present in 11 of 123 (9%) patients. Stroke occurred in 11 out of 212 surgeries (5.2%) on a hemispheric basis. During the 1300.1 hemisphere-years of follow-up more than 1 month after surgery, the annual stroke rate was 0.84%. The postoperative MRA time-of-flight image showed a mean revascularization score of 1.82 ± 0.6 and a mean residual MMV score of 1.91 ± 0.83. Postoperative strokes occurring within 1 month after cerebral revascularization (36.4%, p = 0.0026) and lower revascularization scores (1.82 ± 0.6 vs 2.51 ± 0.59, p = 0.0006) were significant factors related to the presence of ipsilateral late stroke. Logistic regression showed that stroke events within 1 month after revascularization (odds ratio [OR], 9.79; 95% confidence interval [CI], 0.02-0.57; p = 0.0103), low revascularization score (OR, 0.15; 95% CI, 0.001-0.37; p = 0.0069), and high residual MMV score (OR, 16.2; 95% CI, 1.88-187.4; p = 0.0107) were risk factors for ipsilateral stroke more than 1 month after revascularization.
Conclusions:
MMD patients who have a stroke within 1 month after cerebral revascularization are at high risk for late strokes. Less effective revascularization or remarkable residual MMV are risk factors for late stroke events. Additional revascularization may be considered for patients in such situations.
Clinical Trial Registration:
This study was approved by the Bioethics Review Committee of Nagoya University Hospital for the treatment and prognosis of Moyamoya disease (2016-0327).
Insights
Moyamoya disease patients experiencing stroke within one month of revascularization face a higher risk of late strokes. Ineffective revascularization and significant residual Moyamoya vessels are key risk factors.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Medicine
Background:
- Ipsilateral late stroke events after cerebral revascularization for Moyamoya disease (MMD) and their risk factors require further investigation.
- Understanding these risks is crucial for optimizing treatment strategies and improving patient outcomes in MMD.
Purpose of the Study:
- To investigate the incidence and predictive factors of ipsilateral late stroke events occurring more than one month after cerebral revascularization in MMD patients.
- To identify specific risk factors associated with late stroke occurrence to inform clinical management.
Main Methods:
- Retrospective analysis of 123 MMD patients who underwent 212 revascularizations.
- Evaluation of preoperative data, surgical procedures, and ipsilateral stroke events post-surgery.
- Assessment of revascularization and residual Moyamoya vessel (MMV) scores using MRA; logistic regression for predictive factor analysis.
Main Results:
- Late ipsilateral strokes occurred in 9% of patients (11/123) and 5.2% of surgeries (11/212), with an annual stroke rate of 0.84%.
- Strokes within one month post-revascularization (36.4%) and lower revascularization scores (1.82 ± 0.6) were significant factors for late strokes.
- Logistic regression identified early stroke events (OR, 9.79), low revascularization score (OR, 0.15), and high residual MMV score (OR, 16.2) as risk factors for late strokes.
Conclusions:
- MMD patients with stroke within one month of revascularization are at high risk for subsequent late strokes.
- Less effective revascularization and significant residual Moyamoya vessels are identified as risk factors for late stroke events.
- Consideration of additional revascularization may be warranted for patients identified with these risk factors.
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