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Published on: March 27, 2018
Association of Bypass Surgery and Mortality in Moyamoya Disease
Hyunjun Park1, Minkyung Han2, Dong-Kyu Jang1
1Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine The Catholic University of Korea Incheon Republic of Korea.
Insights
Extracranial to intracranial bypass surgery significantly reduces mortality and stroke risk in moyamoya disease (MMD) patients. This MMD treatment offers better outcomes compared to no surgery.
Area of Science:
- Neurology
- Neurosurgery
- Epidemiology
Background:
- Moyamoya disease (MMD) presents a substantial risk of stroke and mortality.
- Effective preventative strategies for MMD complications are crucial.
Purpose of the Study:
- To evaluate the efficacy of extracranial to intracranial bypass surgery in reducing mortality and stroke incidence in MMD patients.
- To compare outcomes between MMD patients who underwent bypass surgery and those who did not.
Main Methods:
- Nationwide retrospective cohort study using Korean National Health Insurance Service data (2006-2019).
- Inclusion of 18,480 MMD patients with a median follow-up of 5.6 years.
- Landmark analyses at 1 month, and 3, 6, 12, and 36 months post-surgery to assess mortality and stroke occurrence.
Main Results:
- Bypass surgery group showed significantly lower all-cause mortality from 36 months onward.
- Reduced risk of any stroke mortality observed from 3- and 6-month landmarks.
- Lower incidence of hemorrhagic stroke mortality and occurrence noted from 6-month landmark.
Conclusions:
- Extracranial to intracranial bypass surgery is associated with reduced all-cause and hemorrhagic stroke mortality in MMD.
- Bypass surgery demonstrates a beneficial effect on reducing hemorrhagic stroke occurrence in MMD patients.
- Surgical intervention offers a protective advantage against stroke and mortality in moyamoya disease.
Background:
Patients with moyamoya disease (MMD) have a high risk of stroke or death. We investigated whether extracranial to intracranial bypass surgery can reduce mortality by preventing strokes in patients with MMD.
Methods And Results:
This nationwide retrospective cohort study encompassed patients with MMD registered under the Rare Intractable Diseases program via the Relieved Co-Payment Policy between 2006 and 2019, using the Korean National Health Insurance Service database. Following a 4-year washout period, landmark analyses were employed to assess mortality and stroke occurrence between the bypass surgery group and the nonsurgical control group at specific time points postindex date (1 month and 3, 6, 12, and 36 months). The study included 18 480 patients with MMD (mean age, 40.7 years; male to female ratio, 1:1.86) with a median follow-up of 5.6 years (interquartile range, 2.5-9.3; mean, 6.1 years [SD, 4.0 years]). During 111 775 person-years of follow-up, 265 patients in the bypass surgery group and 1144 patients in the nonsurgical control group died (incidence mortality rate of 618.1 events versus 1660.3 events, respectively, per 105 person-years). The overall adjusted hazard ratio (HR) revealed significantly lower all-cause mortality in the bypass surgery group from the 36-month landmark time point, for any stroke mortality from 3- and 6-month landmark time points, and for hemorrhagic stroke mortality from the 6-month landmark time point. Furthermore, the overall adjusted HRs for hemorrhagic stroke occurrence were beneficially maintained from all 5 landmark time points in the bypass surgery group.
Conclusions:
Bypass surgery in patients with MMD was associated with a lower risk of all-cause and hemorrhagic stroke mortality and hemorrhagic stroke occurrence compared with nonsurgical control.
