Revascularization of Moyamoya Angiopathy in Older Adults
Background Moyamoya angiopathy most often manifests in patients in the second and third decades of life. Although uncommon, it can also manifest later in life. We present our results in patients >50 years old with moyamoya angiopathy who were treated with surgical revascularization via either direct bypass or indirect bypass (encephaloduroarteriosynangiosis). Methods A retrospective review was conducted to identify patients with moyamoya disease who were treated with surgical revascularization at our institution between 2002 and 2015. Outcomes and complications were analyzed. Results We identified 33 patients with moyamoya angiopathy >50 years old (mean age 59.0 years Â± 7.6) whoÂ were treated with surgical revascularization of 45Â affected hemispheres. Of the affected hemispheres, 27Â (60%) were treated with indirect bypasses and 18Â (40%) were treated with direct bypasses. Neurologic complications occurred in 4 (12%) patients. The mean length of follow-up was 18.7 months Â± 18.6; 4 patients were lost to follow-up. At last follow-up, 11 of 18 (61%) direct bypasses were patent. Treatment failed in 5 of 45Â (11%) treated hemispheres (stroke in 2 and persistent transient ischemic attacks in 3). In terms of functional outcome at last follow-up, 16 of 29 (55%) patients were the same as before surgery, 10 (35%) were better, and 3Â (10%) were worse (including 1 death). Conclusions Although uncommon, moyamoya angiopathy can manifest in older adults. Surgical revascularization is a reasonable treatment option withÂ good functional outcomes and an acceptable complication rate.
Digital Object Identifier (DOI)
Williamson, Richard W.; Abla, Adib A.; Zabramski, Joseph M.; Nakaji, Peter; Spetzler, Robert F.; and Wanebo, John E., "Revascularization of Moyamoya Angiopathy in Older Adults" (2017). Neurosurgery. 362.