Introduction: Moyamoya disease/syndrome (MMD/S) is a progressive, occlusive vasculopathy of the intracranial vasculature that leads to ischemic and hemorrhagic strokes. Significant debate exists regarding the role of indirect versus direct bypass surgery in its management.
Methods: To review our institution’s experience with indirect bypass in the surgical management of patients with MMD/S, we conducated a retrospective review of patients with MMD/S who underwent encephaloduroarteriosynangiosis (EDAS), a form of indirect bypass, from 1996 to present.
Results: 37 patients (52 hemispheres) underwent an EDAS procedure for MMD/S; 21 patients received revascularization of both hemispheres. 49% of patients presented with stroke, 35% presented with TIA, 13% presented with hemorrhage, and 3% presented with seizure. The mean Suzuki grade was 3.46. The number of patients with a mRS of 0-1 improved from 21 to 29 (p=0.002) from the time of surgery to the time of last follow-up. The number of neurologic events (i.e., TIAs, strokes, hemorrhages) decreased from 1.7 (mean) events per patient to 0.14 (p<0.001).
Conclusions: This series demonstrates that EDAS is an effective procedure in improving mRS and reducing neurologic events for MMD/S in a modern North American cohort of patients.
Patient Care: This research adds to the growing body of literature that indirect revascularization continues to be an effective surgical treatment option for adult North American patients with MMD/S. As significant debate does still exist regarding the optimal surgical treatment modality, this research provides clear evidence of the efficacy of the EDAS procedure.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) discuss the basic pathophysiology and epidemiology of moyamoya disease/syndrome; 2) appreciate the difference betweeen Asian and North American MMD/S; 3) discuss the various treatment options avaiable for MMD/S; and 4) discuss the benefits of indirect revascularization for adult North American patients with MMD/S.