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Endovascular treatment for Moyamoya-associated intracranial aneurysms: a systematic review and meta-analysis

Mariana Letícia de Bastos Maximiano1, Ocílio Ribeiro Gonçalves2, Pedro Lucas Machado Magalhães3

  • 1Federal Fluminense University, Niterói, Brazil marianabastosmaximiano@gmail.com.

Journal of Neurointerventional Surgery
|August 11, 2025
PubMed
Abstract

Insights

Endovascular treatment (EVT) is a safe and effective option for moyamoya disease-associated intracranial aneurysms (MMD-IA), showing high occlusion rates and good functional outcomes. Long-term monitoring is crucial due to the risk of aneurysm recurrence.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Interventional Radiology

Background:

  • Moyamoya disease (MMD) involves progressive stenosis of brain arteries, increasing aneurysm risk.
  • MMD-associated intracranial aneurysms (MMD-IA) pose significant clinical challenges.
  • The role of endovascular treatment (EVT) for MMD-IA requires further clarification.

Purpose of the Study:

  • To systematically review and perform a meta-analysis on the safety and efficacy of EVT for MMD-IA.
  • To evaluate functional outcomes and complication rates associated with EVT in MMD-IA patients.
  • To assess long-term outcomes, including aneurysm recurrence, after EVT for MMD-IA.

Main Methods:

  • Comprehensive literature search across major databases (PubMed, Embase, Web of Science) following PRISMA guidelines.
  • Inclusion of 17 studies with 506 patients diagnosed with MMD-IA, focusing on those treated with EVT.
  • Pooled analysis of complete occlusion rates, functional independence (mRS 0-2), procedural complications, and recurrence rates using a random-effects model.

Main Results:

  • EVT achieved a pooled complete occlusion rate of 86.46% immediately post-procedure and 84.51% at last follow-up.
  • Procedure-related complications occurred in 15.27% of cases, with subarachnoid hemorrhage at 5.25% and ischemic complications at 8.69%.
  • Functional independence was achieved in 86.93% of patients, while the aneurysm recurrence rate was 8.08%.

Conclusions:

  • EVT demonstrates safety and efficacy in treating MMD-IA, with high occlusion rates and favorable functional outcomes.
  • The observed recurrence rate underscores the necessity for diligent long-term patient monitoring.
  • Further extensive research is warranted to solidify these findings and refine EVT strategies for MMD-IA.
Keywords:
Aneurysm

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