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Multicenter Study
. 2024 Dec:130:110922.
doi: 10.1016/j.jocn.2024.110922. Epub 2024 Nov 20.

Pretreatment factors associated with symptomatic stroke in Moyamoya disease patients: A multicenter study

Basel Musmar  1 , Joanna M Roy  1 , Hamza Adel Salim  1 , Anand Kaul  1 , Elias Atallah  1 , Kareem El Naamani  2 , Ching-Jen Chen  3 , Roland Jabre  1 , Hassan Saad  4 , Jonathan A Grossberg  4 , Adam A Dmytriw  5 , Aman B Patel  6 , Mirhojjat Khorasanizadeh  7 , Christopher S Ogilvy  7 , Ajith J Thomas  8 , Andre Monteiro  9 , Adnan Siddiqui  9 , Gustavo M Cortez  10 , Ricardo A Hanel  10 , Guilherme Porto  11 , Alejandro M Spiotta  11 , Anthony J Piscopo  12 , David M Hasan  13 , Mohammad Ghorbani  14 , Joshua Weinberg  15 , Shahid M Nimjee  15 , Kimon Bekelis  16 , Mohamed M Salem  17 , Jan-Karl Burkhardt  17 , Akli Zetchi  18 , Charles Matouk  18 , Brian M Howard  4 , Rosalind Lai  6 , Rose Du  6 , Rawad Abbas  1 , Georgios S Sioutas  1 , Abdelaziz Amllay  1 , Alfredo Munoz  1 , Nabeel A Herial  1 , Stavropoula I Tjoumakaris  1 , Michael Reid Gooch  1 , Robert H Rosenwasser  1 , Pascal Jabbour  19
Affiliations
Multicenter Study

Pretreatment factors associated with symptomatic stroke in Moyamoya disease patients: A multicenter study

Basel Musmar et al. J Clin Neurosci. 2024 Dec.

Abstract

Objectives: Moyamoya disease (MMD) is a cerebrovascular disorder marked by the progressive steno-occlusion of the bilateral internal carotid arteries and the formation of abnormal collateral vessel networks at the base of the brain. Previous studies have attempted to identify risk factors predictive of postoperative complications to improve patient management. This study aims to identify pretreatment factors associated with post-bypass symptomatic strokes in MMD patients.

Methods: This study is a multicenter retrospective analysis conducted across 13 academic institutions in North America. A total of 518 patients with MMD were included. Data collected included patient demographics, disease characteristics, and follow-up duration. Stroke-free survival was analyzed using Kaplan-Meier curves. Univariate and multivariable Cox regression analyses were used to identify risk factors for symptomatic stroke.

Results: The median age of the patients was 43 years (IQR, 34-52 years), and 370 (71 %) were females. Multivariable Cox regression identified advanced age (HR 1.03, 95 % CI 1.01-1.05, p = 0.011), female sex (HR 2.03, 95 % CI 1.00-4.11, p = 0.049), diabetes mellitus (HR 2.03, 95 % CI 1.14-3.63, p = 0.016), smoking status (HR 2.27, 95 % CI 1.27-4.05, p = 0.006), and asymptomatic disease (HR 0.37, 95 % CI 0.15-0.93, p = 0.034) as significant factors associated with symptomatic stroke.

Conclusion: Advanced age, female sex, diabetes mellitus, and smoking status were significant predictors of symptomatic stroke in MMD patients after bypass surgery. Asymptomatic patients had a reduced risk of stroke. These findings emphasize the importance of managing modifiable risk factors and the potential benefits of early detection in improving clinical outcomes for MMD patients. Further prospective studies are needed to validate these findings.

Keywords: Moyamoya; Multicenter; Risk factors; Stroke.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Jabbour is a consultant for Medtronic, MicroVention, Balt and Cerus Endovascular. Dr. Tjoumakaris is a consultant for MicroVention. Dr. Gooch is a consultant for Stryker. Dr. Spiotta is a consultant for Terumo, Stryker, Penumbra, RapidAI, Cerenovus. Dr. Patel is a consultant for MicroVention and Medtronic. Dr. Du is a consultant for grand rounds. Dr. Burkhardt is a consultant for Longeviti Neuro solutions, Q-Apel Medical, Stryker. Dr. Hanel is a consultant for Medtronic, Balt, Stryker, Q’Apel Medical, Inc, Codman Neuro (J&J), Cerenovus, Microvention, Imperative Care, Inc, Phenox, Inc, Rapid Medical. Dr. Siddiqui is a consultant for Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus , Cerevatech Medical, Inc., Cordis , Corindus , Inc., Endostream Medical, Ltd, Imperative Care, InspireMD , Ltd., Integra , IRRAS AB, Medtronic, MicroVention , Minnetronix Neuro, Inc., Peijia Medical, Penumbra , Q’Apel Medical, Inc., Rapid Medical, Serenity Medical, Inc., Silk Road Medical, StimMed , LLC, Stryker Neurovascular, Three Rivers Medical, Inc., VasSol , Viz.ai, Inc. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

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