Long-Term Clinical Outcomes After Cerebral Revascularization in Moyamoya Disease With Extracranial Internal Carotid Artery Occlusion.

Objective: The aim of this study is to evaluate the efficacy of cerebral revascularization for Moyamoya disease (MMD) with extracranial internal carotid artery occlusion (ICAO).

Methods: This study retrospectively analyzed 37 patients diagnosed with MMD with extracranial ICAO who underwent cerebral revascularization surgery. We conducted propensity score matching for MMD patients without extracranial ICAO from database of 932 MMD patients. Outcome data, recurrent strokes, and modified Rankin Scale were collected during follow-up.

Results: A total of 37 MMD patients with extracranial ICAO were included in the study. The average follow-up time of MMD patients with extracranial ICAO included in the study was 74 months. During the follow-up period, there were 15 hemispheres recurred stroke events. All hemispheres underwent surgery, and the follow-up modified Rankin Scale score was significantly reduced (P < 0.001). Kaplan-Meier analysis showed no significant statistical difference in stroke events among the indirect bypass, direct bypass, and combined bypass groups (P = 0.131). After propensity matching, 48 hemispheres of MMD patients without extracranial ICAO were identified from a review of 932 MMD patients. There was no significant statistical difference in stroke events between the MMD patients with extracranial ICAO group and the MMD group (P = 0.271).

Conclusions: Cerebral revascularization can prevent recurrent ischemic and hemorrhagic stroke events for MMD patients with extracranial ICAO. There was no difference on long-term clinical outcomes after combined bypass, direct bypass, and indirect bypass surgery. The cerebral revascularization has similar effect on the MMD patients with extracranial ICAO and MMD patients without extracranial ICAO.