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 ± 7.6) who were treated with surgical revascularization of 45 affected hemispheres. Of the affected hemispheres, 27 (60%) were treated with indirect bypasses and 18 (40%) were treated with direct bypasses. Neurologic complications occurred in 4 (12%) patients. The mean length of follow-up was 18.7 months ± 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 45 (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 3 (10%) were worse (including 1 death).

Conclusions: Although uncommon, moyamoya angiopathy can manifest in older adults. Surgical revascularization is a reasonable treatment option with good functional outcomes and an acceptable complication rate.