Long term outcome and predictors of ischemic stroke recurrence in adult moyamoya disease

• Published in: Journal of the neurological sciences Vol. 359; no. 1; pp. 381 - 388
• Main Authors: Noh, Hyun Jin, Kim, Suk Jae, Kim, Jong Soo, Hong, Seung-Chyul, Kim, Keon Ha, Jun, Pyeong, Bang, Oh Young, Chung, Chin-Sang, Lee, Kwang Ho, Lee, Kyung-Han, Kim, Gyeong-Moon
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15-12-2015
• Subjects: Adult; Angiography; Angiography, Digital Subtraction; Brain Ischemia - complications; Brain Ischemia - etiology; Cerebral Revascularization - methods; Cerebral vascular reserve; Female; Humans; Intracranial stenosis; Ischemic stroke; Kaplan-Meier Estimate; Longitudinal Studies; Male; Middle Aged; Moyamoya disease; Moyamoya Disease - complications; Moyamoya Disease - surgery; Neurology; Predictive Value of Tests; Proportional Hazards Models; Recurrence; Retrospective Studies; Stroke - diagnosis; Stroke - etiology; Stroke - surgery; Stroke recurrence; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Cerebral vascular reserve; Moyamoya disease; Stroke recurrence; Ischemic stroke; Angiography; Intracranial stenosis
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2015.11.018

Abstract Objective We sought to identify the clinical outcome and predictors for ischemic stroke recurrence in adults with symptomatic moyamoya disease (MMD). Methods We analyzed 104 adult MMD patients with ischemic stroke or TIA registered at our institution. All patients underwent digital subtraction angiography and single photon emission computed tomography to measure disease severity and cerebral vascular reserve (CVR). A Cox regression model was used to identify predictors of recurrent ischemic stroke. Results Fifty-nine patients were non-surgically treated and 45 patients were surgically treated. In the non-surgical group, the Kaplan–Meier estimate of ischemic stroke recurrence was 1.6% in the first year and 11.8% in the 5th year. Hypertension (hazard ratio [HR] = 0.07, 95% confidence interval [CI] 0.01–0.99), diabetes (HR = 35.16, 95% CI 2.61–474.16), presence of steno-occlusive lesion in posterior cerebral arteries (HR = 17.53, 95% CI 2.02–152.43), and extended or global decreased CVR (HR = 13.62, 95% CI 1.55–119.84) were independent predictors of recurrence. In the surgical group, the Kaplan–Meier estimate of ischemic stroke recurrence was 24.4% in the first year and 24.4% in the 5th year. Half of the recurred patients experienced recurrent ischemic strokes postoperatively. Diabetes was the only predictor of recurrent ischemic stroke (HR = 6.17, 95% CI 1.31–29.14). Conclusions In non-surgically treated MMD, PCA stenosis and CVR were identified as predictors of ischemic stroke recurrence. Diabetes was an independent predictor of recurrent ischemic stroke in both non-surgical and surgically treated MMD groups.