Journal article
Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study
Journal of neurology, neurosurgery and psychiatry, Vol.95(3), pp.256-263
03/2024
DOI: 10.1136/jnnp-2022-329176
Abstract
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 revascularisation (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 guidelines of moyamoya affected hemispheres treated with DR and IR 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 (95% CI 0.651 to 2.354), p=0.514). The rate of total perioperative strokes was slightly higher in the DR cohort (6.1% for DR vs 2.0% for IR, OR 3.129 (95% CI 0.991 to 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 (95% CI 0.374 to 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.
Details
- Title: Subtitle
- Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study
- Creators
- Kareem El NaamaniChen Ching-JenRoland JabreHassan SaadJonathan GrossbergAdam DmytriwAman PatelMirhojjat KhorasanizadehChristopher OgilvyAjith ThomasAndre MonteiroAdnan SiddiquiGustavo CortezRicardo HanelGuilherme PortoAlejandro SpiottaAnthony PiscopoDavid HasanMohammad GhorbaniJoshua WeinbergShahid NimjeeKimon BekelisMohamed SalemJan-Karl BurkhardtAkli ZetchiCharles MatoukBrian HowardRosalind LaiRose DuRawad AbbasGeorgios SioutasAbdelaziz AmllayAlfredo MunozElias AtallahNabeel HerialStavropoula TjoumakarisMichael Reid GoochRobert RosenwasserPascal Jabbour
- Resource Type
- Journal article
- Publication Details
- Journal of neurology, neurosurgery and psychiatry, Vol.95(3), pp.256-263
- Publisher
- BMJ Publishing Group LTD
- DOI
- 10.1136/jnnp-2022-329176
- ISSN
- 0022-3050
- eISSN
- 1468-330X
- Language
- English
- Electronic publication date
- 09/01/2023
- Date published
- 03/2024
- Academic Unit
- Neurosurgery; Roy J. Carver Department of Biomedical Engineering
- Record Identifier
- 9984461803802771
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