E-219 Direct vs indirect revascularization for moyamoya: a large multicenter study

K El Naamani; C Chen; R Jabre; H Saad; J Grissberg; A Dmytriw; A Patel; M Khorasanizadeh; C Ogilvy; A Thomas; A Monteiro; A Siddiqui; G Cortez; R Hanel; G Porto; A Spiotta; A Piscopo; D Hasan; M Ghorbani; J Weinberg; S Nimjee; K Bekelis; M Salem; J Burkhardt; A Zetchi; C Matouk; B Howard; R Lai; R Du; R Abbas; G Sioutas; A Amllay; A Munoz; E Atallah; N Herial; S Tjoumakaris; M Gooch; R Rosenwasser; P Jabbour

doi:10.1136/jnis-2023-SNIS.318

Background Moyamoya is a chronic occlusive cerebrovascular disease of unknown etiology causing neovascularization of the lenticulostriate collaterals at the base of the brain. Although revascularization surgery is the most effective treatment for moyamoya, there is still no consensus on the best surgical treatment modality as different studies provide different outcomes. Objective In this large case series, we compare the outcomes of direct (DR) and indirect revascularization (IR) and compare our results to the literature in order to reflect on the best revascularization modality for moyamoya. Methods We conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines of moyamoya affected hemispheres treated with direct and indirect revascularization surgeries across 13 academic institutions predominantly in North America. All patients who underwent surgical revascularization of their moyamoya-affected hemispheres were included in the study. The primary outcome of the study was the rate of symptomatic strokes. Results The rates of symptomatic strokes across 515 disease-affected hemispheres were comparable between the two cohorts (11.6% in the DR cohort vs 9.6% in the IR cohort, OR=1.238 [0.651-2.354], p=0.514). The rate of total peri-operative strokes was slightly higher in the DR cohort (6.1% for DR vs 2.0% for IR, OR=3.129 [0.991-9.875], p= 0.052). The rate of total follow-up strokes was slightly higher in the IR cohort (8.1% vs 6.6%, OR=0.799 [0.374-1.709] p=0.563). Conclusion Since both modalities showed comparable rates of overall total strokes, both modalities of revascularization can be performed depending on the patient’s risk assessment.Abstract E-219 Table 1 Direct Indirect Effect variable Value (95% confidence interval) P-value Primary Outcome Symptomatic stroke, n (%) 23/198 (11.6) 19/198 (9.6) Odds ratio 1.238 (0.651-2.354) 0.514 Secondary Outcomes Symptomatic ischemic stroke, n (%) 23/198 (11.6) 16/198 (8.1) Odds ratio 1.495 (0.764-2.924) 0.240 Symptomatic hemorrhagic stroke, n (%) 0/198 (0) 3/198 (1.5) –– –– 0.248 Peri-operative stroke, n (%) 12/198 (6.1) 4/198 (2.0) Odds ratio 3.129 (0.991-9.875) 0.052 Peri-operative minor symptomatic stroke, n (%) 7/198 (3.5) 2/198 (1.0) Odds ratio 3.592 (0.737-17.508) 0.114 Peri-operative major symptomatic stroke, n (%) 5/198 (2.5) 2/198 (1.0) Odds ratio 2.539 (0.487-13.244) 0.269 Intra-operative complication, n (%) 14/198 (7.1) 15/198 (7.6) Odds ratio 0.928 (0.436-1.978) 0.847 Good functional outcome at discharge, n (%) 182/198 (91.9) 187/198 (95.4) Odds ratio 0.547 (0.236-1.270) 0.161 NIHSS at discharge, median (IQR) 0 (0-0.5) 0 (0-1) Beta 0.510 (-0.065-1.085) 0.082 Length of hospital stay, median (IQR) 3 (2-4) 4 (3-5) Beta 0.763 (-0.042-1.568) 0.063 Follow-up stroke, n (%) 13/198 (6.6) 16/198 (8.1) Odds ratio 0.799 (0.374-1.709) 0.563 Follow-up ischemic stroke, n (%) 13/198 (6.6) 14/198 (7.1) Odds ratio 0.924 (0.423-2.019) 0.842 Follow-up hemorrhagic stroke, n (%) 0/198 (0) 3/198 (1.5) –– –– 0.248 Comparison of outcomes between matched cerebral hemispheres treated with direct vs. indirect bypasses.*Fisher’s exact test Disclosures K. El Naamani: None. C. Chen: None. R. Jabre: None. H. Saad: None. J. Grissberg: None. A. Dmytriw: None. A. Patel: None. M. Khorasanizadeh: None. C. Ogilvy: None. A. Thomas: None. A. Monteiro: None. A. Siddiqui: None. G. Cortez: None. R. Hanel: None. G. Porto: None. A. Spiotta: None. A. Piscopo: None. D. Hasan: None. M. Ghorbani: None. J. Weinberg: None. S. Nimjee: None. K. Bekelis: None. M. Salem: None. J. Burkhardt: None. A. Zetchi: None. C. Matouk: None. B. Howard: None. R. Lai: None. R. Du: None. R. Abbas: None. G. Sioutas: None. A. Amllay: None. A. Munoz: None. E. Atallah: None. N. Herial: None. S. Tjoumakaris: 2; C; Microvention, Medtronic. M. Gooch: 2; C; Stryker. R. Rosenwasser: None. P. Jabbour: 2; C; Medtronic, Microvention, Balt, Cerus Endovascular.

E-219 Direct vs indirect revascularization for moyamoya: a large multicenter study

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