Abstract
Revascularization surgery is considered a standard treatment for preventing additional stroke in symptomatic moyamoya disease (MMD). In hemodynamically stable, and asymptomatic or mildly symptomatic patients, however, the treatment strategy is controversial because of the obscure natural course of them. The authors analyzed the benefits and risks of antiplatelet medication in those patients. Medical data were retrospectively reviewed in 439 hemispheres of 243 patients with stable hemodynamic status. Overall, 121 patients (49.8%) with 222 studied hemispheres (50.6%) took antiplatelet medication. Symptomatic cerebral infarction and hemorrhage occurred in 10 (2.3%) and 30 (6.8%) hemispheres, over a mean follow-up of 62.0 ± 43.4 months (range 6–218 months). The use of antiplatelet agents was statistically insignificant in terms of symptomatic infarction, hemorrhage and improvement of ischemic symptoms. In subgroup analyses within the antiplatelet group according to drug potency and duration of medication, a longer duration of antiplatelet medication significantly improved ischemic symptoms (adjusted OR 1.02; 95% CI 1.01–1.03; p = 0.006). Antiplatelet medication failed to prevent symptomatic cerebral infarction or improve ischemic symptoms. However, antiplatelet therapy did not increase the risk of cerebral hemorrhage.
Highlights
Revascularization surgery is considered a standard treatment for preventing additional stroke in symptomatic moyamoya disease (MMD)
The authors performed a retrospective study to determine whether antiplatelet agents were useful to prevent symptomatic cerebral infarction and to improve ischemic symptoms and whether those agents were safe and caused no cerebral hemorrhage in hemodynamically stable adult MMD
Inclusion criteria were as follows: (1) age ≥ 20 years; (2) compatibility with the diagnostic guidelines of the MMDs4,5,7; (3) an initial clinical follow-up without surgery of at least 6 months or more; (4) initially mild or fixed symptoms related to hemorrhage and ischemia, or asymptomatic presentation; (5) hemodynamically stable status on single-photon-emission computed tomography (SPECT); and (6) medical records pertaining to the evaluation of certain concomitant medical conditions at the first visit and during the follow-up period
Summary
Revascularization surgery is considered a standard treatment for preventing additional stroke in symptomatic moyamoya disease (MMD). The use of antiplatelet agents was statistically insignificant in terms of symptomatic infarction, hemorrhage and improvement of ischemic symptoms. Antiplatelet medication failed to prevent symptomatic cerebral infarction or improve ischemic symptoms. Revascularization surgery is accepted as an effective treatment to prevent additional stroke in symptomatic patients with ischemic and hemorrhagic MMD10,11. In hemodynamically stable adult MMD, optimal management considering perioperative complications and the natural course of the disease is still controversial.
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