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Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study.

Publication ,  Journal Article
El Naamani, K; Chen, C-J; Jabre, R; Saad, H; Grossberg, JA; Dmytriw, AA; Patel, AB; Khorasanizadeh, M; Ogilvy, CS; Thomas, A; Monteiro, A ...
Published in: J Neurol Neurosurg Psychiatry
February 14, 2024

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.

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Published In

J Neurol Neurosurg Psychiatry

DOI

EISSN

1468-330X

Publication Date

February 14, 2024

Volume

95

Issue

3

Start / End Page

256 / 263

Location

England

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Moyamoya Disease
  • Humans
  • Cerebral Revascularization
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 17 Psychology and Cognitive Sciences
 

Citation

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El Naamani, K., Chen, C.-J., Jabre, R., Saad, H., Grossberg, J. A., Dmytriw, A. A., … Jabbour, P. (2024). Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study. J Neurol Neurosurg Psychiatry, 95(3), 256–263. https://doi.org/10.1136/jnnp-2022-329176
El Naamani, Kareem, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan A. Grossberg, Adam A. Dmytriw, Aman B. Patel, et al. “Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study.J Neurol Neurosurg Psychiatry 95, no. 3 (February 14, 2024): 256–63. https://doi.org/10.1136/jnnp-2022-329176.
El Naamani K, Chen C-J, Jabre R, Saad H, Grossberg JA, Dmytriw AA, et al. Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study. J Neurol Neurosurg Psychiatry. 2024 Feb 14;95(3):256–63.
El Naamani, Kareem, et al. “Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study.J Neurol Neurosurg Psychiatry, vol. 95, no. 3, Feb. 2024, pp. 256–63. Pubmed, doi:10.1136/jnnp-2022-329176.
El Naamani K, Chen C-J, Jabre R, Saad H, Grossberg JA, Dmytriw AA, Patel AB, Khorasanizadeh M, Ogilvy CS, Thomas A, Monteiro A, Siddiqui A, Cortez GM, Hanel RA, Porto G, Spiotta AM, Piscopo AJ, Hasan DM, Ghorbani M, Weinberg J, Nimjee SM, Bekelis K, Salem MM, Burkhardt J-K, Zetchi A, Matouk C, Howard BM, Lai R, Du R, Abbas R, Sioutas GS, Amllay A, Munoz A, Atallah E, Herial NA, Tjoumakaris SI, Gooch MR, Rosenwasser RH, Jabbour P. Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study. J Neurol Neurosurg Psychiatry. 2024 Feb 14;95(3):256–263.

Published In

J Neurol Neurosurg Psychiatry

DOI

EISSN

1468-330X

Publication Date

February 14, 2024

Volume

95

Issue

3

Start / End Page

256 / 263

Location

England

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Moyamoya Disease
  • Humans
  • Cerebral Revascularization
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 17 Psychology and Cognitive Sciences