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SNIS 20th annual meeting electronic poster abstracts
E-219 Direct vs indirect revascularization for moyamoya: a large multicenter study
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  1. K El Naamani1,
  2. C Chen1,
  3. R Jabre1,
  4. H Saad2,
  5. J Grissberg2,
  6. A Dmytriw3,
  7. A Patel4,
  8. M Khorasanizadeh5,
  9. C Ogilvy5,
  10. A Thomas6,
  11. A Monteiro7,
  12. A Siddiqui7,
  13. G Cortez8,
  14. R Hanel8,
  15. G Porto9,
  16. A Spiotta9,
  17. A Piscopo10,
  18. D Hasan11,
  19. M Ghorbani12,
  20. J Weinberg13,
  21. S Nimjee13,
  22. K Bekelis14,
  23. M Salem15,
  24. J Burkhardt16,
  25. A Zetchi17,
  26. C Matouk17,
  27. B Howard2,
  28. R Lai4,
  29. R Du4,
  30. R Abbas1,
  31. G Sioutas1,
  32. A Amllay1,
  33. A Munoz1,
  34. E Atallah1,
  35. N Herial1,
  36. S Tjoumakaris1,
  37. M Gooch1,
  38. R Rosenwasser1,
  39. P Jabbour1
  1. 1Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
  2. 2Neurosurgery, Emory University, Atlanta, GA, USA
  3. 3Medical Imaging and Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
  4. 4Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
  5. 5Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
  6. 6Neurosurgery, Medical School of Rowan University, Camden, NJ, USA
  7. 7Neurosurgery, University of New York at Buffalo, Buffalo, NY, USA
  8. 8Neurosurgery, Baptist Health System, Jacksonville, FL, USA
  9. 9Neurosurgery, Medical University of South Carolina, South Carolina, SC, USA
  10. 10Neurosurgery, , University of Iowa Hospital and Clinics, Iowa City, IA, USA
  11. 11Neurosurgery, Duke University, Durham, NC, USA
  12. 12Neurosurgery, Firzoogar Hospital, Iran, Iran, Islamic Republic of
  13. 13Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
  14. 14Neurosurgery, Good Samaritan Hospital Medical Center, Babylon, NY, USA
  15. 15Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
  16. 16Neurosurgery, Hospital of the University of PennsylvaniaThomas Jefferson University Hospital, Philadelphia, PA, USA
  17. 17Neurosurgery, Yale University, New Haven, CT, USA

Abstract

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 revascularization (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 (STROBE) guidelines of moyamoya affected hemispheres treated with direct and indirect revascularization 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 [0.651-2.354], p=0.514). The rate of total peri-operative strokes was slightly higher in the DR cohort (6.1% for DR vs 2.0% for IR, OR=3.129 [0.991-9.875], 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 [0.374-1.709] 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.

View this table:
Abstract E-219 Table 1

Disclosures K. El Naamani: None. C. Chen: None. R. Jabre: None. H. Saad: None. J. Grissberg: None. A. Dmytriw: None. A. Patel: None. M. Khorasanizadeh: None. C. Ogilvy: None. A. Thomas: None. A. Monteiro: None. A. Siddiqui: None. G. Cortez: None. R. Hanel: None. G. Porto: None. A. Spiotta: None. A. Piscopo: None. D. Hasan: None. M. Ghorbani: None. J. Weinberg: None. S. Nimjee: None. K. Bekelis: None. M. Salem: None. J. Burkhardt: None. A. Zetchi: None. C. Matouk: None. B. Howard: None. R. Lai: None. R. Du: None. R. Abbas: None. G. Sioutas: None. A. Amllay: None. A. Munoz: None. E. Atallah: None. N. Herial: None. S. Tjoumakaris: 2; C; Microvention, Medtronic. M. Gooch: 2; C; Stryker. R. Rosenwasser: None. P. Jabbour: 2; C; Medtronic, Microvention, Balt, Cerus Endovascular.

https://doi.org/10.1136/jnis-2023-SNIS.318

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