Ipsilateral late stroke after revascularization surgery for patients with Moyamoya disease

Abstract

Background

Ipsilateral late stroke events occurring after cerebral revascularization for Moyamoya disease (MMD) and their risk factors have not been fully investigated.

Methods

We retrospectively analyzed 123 patients with MMD who underwent 212 revascularizations. We investigated preoperative demographic data, surgical procedures, and ipsilateral stroke events occurring more than 1 month after surgery. The effect of revascularization and the residual Moyamoya vessel (MMV) score were examined using magnetic resonance angiography (MRA). Then, predictive factors for postoperative late stroke occurrence were evaluated by logistic regression.

Results

The mean age was 26 ± 18.4 years (range 1 to 66 years). Ipsilateral late stroke events were present in 11 of 123 (9%) patients. Stroke occurred in 11 out of 212 surgeries (5.2%) on a hemispheric basis. During the 1300.1 hemisphere-years of follow-up more than 1 month after surgery, the annual stroke rate was 0.84%. The postoperative MRA time-of-flight image showed a mean revascularization score of 1.82 ± 0.6 and a mean residual MMV score of 1.91 ± 0.83. Postoperative strokes occurring within 1 month after cerebral revascularization (36.4%, p = 0.0026) and lower revascularization scores (1.82 ± 0.6 vs 2.51 ± 0.59, p = 0.0006) were significant factors related to the presence of ipsilateral late stroke. Logistic regression showed that stroke events within 1 month after revascularization (odds ratio [OR], 9.79; 95% confidence interval [CI], 0.02–0.57; p = 0.0103), low revascularization score (OR, 0.15; 95% CI, 0.001–0.37; p = 0.0069), and high residual MMV score (OR, 16.2; 95% CI, 1.88–187.4; p = 0.0107) were risk factors for ipsilateral stroke more than 1 month after revascularization.

Conclusions

MMD patients who have a stroke within 1 month after cerebral revascularization are at high risk for late strokes. Less effective revascularization or remarkable residual MMV are risk factors for late stroke events. Additional revascularization may be considered for patients in such situations.

Clinical trial registration

This study was approved by the Bioethics Review Committee of Nagoya University Hospital for the treatment and prognosis of Moyamoya disease (2016-0327).

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Funding

This work was funded by a grant from the Japan Society for the Promotion of Science (No. 7118 K08967, https://www.jsps.go.jp).

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Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by YA, KY, and KU. The first draft of the manuscript was written by YA, and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yoshio Araki.

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The authors declare that they have no conflicts of interest.

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All the procedures in studies involving human participants were performed in accordance with the ethical standards of the institutional or national research committee and with either the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent was not required.

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This article is part of the Topical Collection on Vascular Neurosurgery

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Araki, Y., Yokoyama, K., Uda, K. et al. Ipsilateral late stroke after revascularization surgery for patients with Moyamoya disease. Acta Neurochir (2021). https://doi.org/10.1007/s00701-021-04773-8

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Keywords

  • Moyamoya disease,
  • Moyamoya vessel,
  • Postoperative stroke,
  • Revascularization surgeries