Journal article
Clinical features and outcome in north american adults with moyamoya phenomenon
Stroke (1970), Vol.37(6), pp.1490-1496
2006
DOI: 10.1161/01.STR.0000221787.70503.ca
PMID: 16645133
Abstract
Background and purpose: To describe baseline clinical features and outcomes of adults with moyamoya phenomenon treated at a single North American institution.
Methods: We identified 34 adults with moyamoya phenomenon by review of angiographic records. Clinical presentation and baseline stroke risk factors were obtained by chart review. Follow-up was obtained prospectively. A 5-year Kaplan-Meier stroke risk was calculated.
Results: The median age was 42 (range 20 to 79) years. Twenty-five were women. The initial symptom was ischemia, hemorrhage, or asymptomatic in 24, 7, and 3 patients, respectively. Twenty-two had bilateral involvement and 12 had unilateral moyamoya vessels. Baseline stroke risk factors were similar between groups. The median follow-up in 31 living patients was 5.1 (range 0.2 to 19.6) years. Fourteen patients were treated with surgical revascularization (20 total hemispheres). In medically treated symptomatic hemispheres, the 5-year risk of recurrent ipsilateral stroke was 65% after the initial symptom and 27% after angiographic diagnosis. Patients with bilateral involvement presenting with ischemic symptoms were at the highest risk of subsequent stroke (n=17, 5-year risk of stroke with medical treatment after first symptom of 82%). In surgically treated hemispheres, the 5-year risk of perioperative or subsequent ipsilateral stroke or death was 17%. This was significantly different compared with medical treatment after first symptom (P=0.02) but not after angiographic diagnosis.
Conclusions: Moyamoya phenomenon in North American adults is associated with a high risk of recurrent stroke, particularly those with bilateral involvement and ischemic symptoms. These data suggest a potential benefit with surgery if diagnosis could be made earlier.
Details
- Title: Subtitle
- Clinical features and outcome in north american adults with moyamoya phenomenon
- Creators
- Christopher L HALLEMEIER - Interventional Neuroradiology Section, Mallinckrodt Institute of Radiology, United StatesKeith M RICH - Department of Neurological Surgery, Washington University School of Medicine, St Louis, Mo, United StatesRobert L GRUBB - Department of Neurological Surgery, Washington University School of Medicine, St Louis, Mo, United StatesMichael R CHICOINE - Department of Neurological Surgery, Washington University School of Medicine, St Louis, Mo, United StatesChristopher J MORAN - Interventional Neuroradiology Section, Mallinckrodt Institute of Radiology, United StatesDewitte T CROSS - Interventional Neuroradiology Section, Mallinckrodt Institute of Radiology, United StatesGregory J ZIPFEL - Department of Neurological Surgery, Washington University School of Medicine, St Louis, Mo, United StatesRalph G DACEY - Department of Neurological Surgery, Washington University School of Medicine, St Louis, Mo, United StatesColin P DERDEYN - Interventional Neuroradiology Section, Mallinckrodt Institute of Radiology, United States
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.37(6), pp.1490-1496
- Publisher
- Lippincott Williams & Wilkins; Hagerstown, MD
- DOI
- 10.1161/01.STR.0000221787.70503.ca
- PMID
- 16645133
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 2006
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020610002771
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