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Antiplatelet Treatment in Moyamoya Disease: A Systematic Review
Naruchorn Kijpaisalratana1,2,3, Chanon Ariyaprakai4, Kitiporn Sriamornrattanakul4
1Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Introduction:
Moyamoya disease (MMD) is an uncommon cause of stroke. Antiplatelet treatment is commonly prescribed for patients with MMD despite the lack of strong evidence supporting its efficacy. We conducted a systematic review to evaluate evidence of antiplatelet treatment and clinical outcomes among patients with MMD.
Methods:
A systematic literature search was performed to identify studies that evaluated the association between antiplatelet treatment and clinical outcomes, including ischemic stroke, hemorrhagic stroke, functional outcome, survival, and bypass patency, in patients with MMD. The following databases were searched: PubMed, Embase, Scopus, and the Cochrane Library, from the inception date to February 2022.
Results:
Eight studies were included in this systematic review. Six studies evaluated antiplatelet treatment and ischemic stroke. Most studies did not demonstrate a protective effect of antiplatelet treatment against ischemic stroke. Five studies evaluated antiplatelet treatment and hemorrhagic stroke. All of them did not demonstrate an increased risk of hemorrhagic stroke. One study found the benefit of antiplatelet treatment in terms of survival. Regarding the effect of antiplatelet treatment on functional outcome and patency of surgical bypass, the results were inconclusive.
Conclusion:
Current evidence suggests that antiplatelet treatment in patients with MMD did not demonstrate a protective effect against ischemic stroke. However, antiplatelet treatment did not increase the risk of hemorrhagic stroke in patients with MMD. The well-designed randomized controlled trial should be highlighted.
Insights
Antiplatelet treatment for Moyamoya disease (MMD) shows no protective effect against ischemic stroke. However, it does not increase the risk of hemorrhagic stroke in MMD patients.
Area of Science:
- Neurology
- Vascular Neurology
- Clinical Trials
Background:
- Moyamoya disease (MMD) is a rare cerebrovascular disorder leading to stroke.
- Antiplatelet therapy is frequently used in MMD despite limited evidence of effectiveness.
- This review assesses antiplatelet treatment's impact on MMD clinical outcomes.
Purpose of the Study:
- To systematically review the evidence on antiplatelet treatment efficacy in Moyamoya disease.
- To evaluate the association between antiplatelet therapy and various clinical outcomes in MMD patients.
Main Methods:
- A comprehensive literature search was conducted across major databases (PubMed, Embase, Scopus, Cochrane Library) up to February 2022.
- Studies examining antiplatelet treatment and outcomes like ischemic/hemorrhagic stroke, functional status, survival, and bypass graft patency were included.
Main Results:
- Eight studies were analyzed. Most found no significant protective effect of antiplatelet agents against ischemic stroke.
- No increased risk of hemorrhagic stroke was observed with antiplatelet use.
- Evidence on functional outcomes and bypass graft patency was inconclusive; one study suggested survival benefits.
Conclusions:
- Current evidence does not support antiplatelet treatment for preventing ischemic stroke in Moyamoya disease.
- Antiplatelet therapy appears safe regarding hemorrhagic stroke risk in MMD.
- High-quality randomized controlled trials are needed to clarify treatment efficacy.
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