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The AMORE Score for Predicting the 5-Year Risk of Hemorrhagic Stroke in Asymptomatic Moyamoya Disease

Tomohito Hishikawa1, Satoshi Murai2, Yoichi M Ito3

  • 1Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan, thishi@med.kawasaki-m.ac.jp.

Cerebrovascular Diseases (Basel, Switzerland)
|January 30, 2026
PubMed
Abstract

Insights

The AMORE score effectively predicts the 5-year hemorrhagic stroke risk in asymptomatic moyamoya disease (MMD) patients. This score, based on age, choroidal anastomosis, and microbleeds, aids in risk stratification for MMD.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Neuroimaging

Background:

  • Asymptomatic moyamoya disease (MMD) poses a risk of hemorrhagic stroke.
  • Accurate prediction of this risk is crucial for patient management.
  • Existing risk stratification tools for MMD may require refinement.

Purpose of the Study:

  • To establish a predictive score for the 5-year risk of hemorrhagic stroke in asymptomatic moyamoya disease (MMD) patients.
  • To evaluate the reproducibility of the developed prediction score using the Asymptomatic Moyamoya Registry (AMORE) data.

Main Methods:

  • Prospective cohort study involving 103 patients with asymptomatic MMD from 18 Japanese centers.
  • Multivariate analysis identified age ≥46 years, Grade -2 choroidal anastomosis, and microbleeds as key predictive variables.
  • Kaplan-Meier method and Bootstrap resampling were used to estimate and assess the reproducibility of 5-year hemorrhagic stroke risk.

Main Results:

  • The AMORE score (0-3 points) was developed, incorporating age, choroidal anastomosis, and microbleeds.
  • Estimated 5-year hemorrhagic stroke risks per hemisphere were 1.8% (score 0), 1.6% (score 1), 15.4% (score 2), and 50.0% (score 3).
  • Significantly higher risk observed for AMORE score 3 compared to scores 0 and 1 (HR > 38, p < 0.003).

Conclusions:

  • The AMORE score provides an adequate estimation of the 5-year hemorrhagic stroke risk in patients with asymptomatic moyamoya disease.
  • The score facilitates risk stratification and may inform clinical decision-making for asymptomatic MMD patients.
Keywords:
Asymptomatic moyamoya diseaseHemorrhagic strokeRisk score

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