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Risk Factors Influencing Disease Onset and Surgical Outcomes in Moyamoya Disease

Xuhua Cao¹, Liyi Wang², Zhizhao Ma¹

¹Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, People's Republic of China.

Journal of Multidisciplinary Healthcare

|February 19, 2026

Abstract

Objective:

The aim of this study is to explore the risk factors associated with the onset and clinical progression of moyamoya disease (MMD), as well as the outcomes of combined revascularization surgery (RS).

Methods:

A retrospective analysis was performed on the medical records of 226 individuals diagnosed with MMD who underwent combined RS at the Department of Neurosurgery in 2022. Binary logistic regression analysis was used to identify risk factors related to the occurrence of cerebral ischemia (CIS), postoperative complications, lateralization of MMD involvement, progression from unilateral to bilateral MMD, and disease severity in cases presenting with CIS. Surgical effectiveness was assessed during follow-up.

Results:

Hypertension (odds ratio [OR] = 1.816, 95% confidence interval [CI]: 1.031-3.197) and higher preoperative modified Rankin Scale scores (OR = 5.164, 95% CI: 1.145-23.295) were identified as independent risk factors for CIS. Male sex (OR = 4.219, 95% CI: 1.470-12.195) and age ≥ 50 years (OR = 3.979, 95% CI: 1.494-10.598) were independent predictors of postoperative complications following RS. No independent factors were associated with the affected side or bilateral progression of MMD (P > 0.05). Disease severity in patients with CIS was influenced by both Suzuki staging and age. The effective rate of RS at 3-6 months postoperatively was 96.46%.

Conclusion:

Early intervention is recommended, particularly for male patients and those with modifiable risk factors such as hypertension. RS should ideally be performed during the early stages of Suzuki classification and before the age of 50 to reduce the risk of postoperative complications. For patients with advanced Suzuki stage or aged ≥ 50 years, comprehensive perioperative risk assessments and tailored postoperative management strategies are essential to ensure optimal surgical outcomes.

Insights

Hypertension and higher preoperative scores increase stroke risk in moyamoya disease (MMD). Male sex and age over 50 predict complications after revascularization surgery (RS), which is 96.46% effective.

Area of Science:

Neurology
Neurosurgery
Vascular Surgery

Background:

Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of the internal carotid arteries and their branches.
Identifying risk factors for MMD onset, progression, and surgical outcomes is crucial for patient management.

Purpose of the Study:

To explore risk factors for moyamoya disease (MMD) onset and progression.
To evaluate the outcomes of combined revascularization surgery (RS) for MMD.
To identify predictors of cerebral ischemia (CIS) and postoperative complications.

Main Methods:

Retrospective analysis of 226 MMD patients who underwent combined RS.
Binary logistic regression to identify risk factors for CIS, postoperative complications, MMD progression, and disease severity.
Surgical effectiveness assessed via follow-up.

Main Results:

Hypertension and higher preoperative modified Rankin Scale scores are independent risk factors for CIS.
Male sex and age ≥ 50 years predict postoperative complications after RS.
RS demonstrated a 96.46% effective rate at 3-6 months postoperatively.

Conclusions:

Early RS intervention is recommended, especially for male patients and those with hypertension.
Performing RS before age 50 and in early Suzuki stages may reduce complications.
Tailored perioperative management is essential for older patients or those with advanced MMD stages.

Read full analysis

Keywords:

Suzuki staging affected side cerebral ischemia combined revascularization surgery mRS score moyamoya disease

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