Clinical Efficacy of Revascularization Surgery for Moyamoya Angiopathy: Long-Term Results of a European Cohort.

BACKGROUND

Moyamoya angiopathy (MMA) is a cerebrovascular disease treated by surgical revascularization. This study aimed to present long-term outcomes of European MMA patients after surgical revascularization.

METHODS

MMA patients treated surgically between 1998 to 2023 were included. Follow-up comprised clinical and radiological examinations and electronic questionnaires. Patient data were analyzed retrospectively, and logistic regressions were performed to identify predictors of unfavorable outcomes.

RESULTS

A total of 276 patients with 428 surgically treated hemispheres were included. The mean age was 35.0 ± 17.2 years, including 192 women and 84 men, predominantly of Caucasian ethnicity (88.0%). Ischemia (82.2%) and hemorrhage (10.1%) were the most common symptoms at onset. Most adults (80.9%) were treated with combined bypass surgery via mini-craniotomy. Within 30 days, complications occurred in 6.3% of surgeries, and the perioperative stroke risk was 2.6%. A total of 148 patients underwent in-house follow-up. No mRS scores ≥ 5 were observed, with 86.3% of patients achieving a score of 0-2, alongside a bypass patency rate of 95.7% and a stroke risk of 0.3% per patient-year. Preoperative stroke and silent ischemic MRI lesions were identified as predictors of an unfavorable outcome. Additionally, 201 patients were followed up electronically. No mRS scores ≥ 5 were observed, with 87.9% of patients achieving a score of 0-2. Moreover, 90.7% were independent in daily life, but only 50.5% returned to work or school.

CONCLUSIONS

Combined bypass surgery yielded favorable outcomes with low complication and stroke rates. Patients with preoperative stroke require closer follow-up, and individualized strategies are needed to address persistent functional impairments.