Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: Results of the Japan adult moyamoya trial

Susumu Miyamoto, Takashi Yoshimoto, Nobuo Hashimoto, Yasushi Okada, Ichiro Tsuji, Teiji Tominaga, Jyoji Nakagawara, Jun C. Takahashi, Keisuke Yamada, Yasutake Tomata, Tsuguya Fukui, Yasuo Fukuuchi, Takashi Ohmoto, Yasuo Kuwabara, Izumi Nagata, Junichi Ono, Toshio Machida, Ryuji Sakakibara, Kanji Yamane, Shinji OkitaToru Iwama, Yasuhiko Kaku, Nobuhito Saito, Hidenao Fukuyama, Kiyohiro Houkin, Satoshi Kuroda, Ichiro Yabe, Fumio Moriwaka, Akira Ogawa, Kuniaki Ogasawara, Kenji Yoshida, Kiyotaka Fujii, Masaru Yamada, Kimitoshi Sato, Tsugio Akutsu, Sen Yamagata, Shigekazu Takeuchi, Kentaro Hayashi, Nobutaka Horie, Kazuo Yamada, Toshiaki Osato, Toshiichi Watanabe, Kaori Honjo, Kazuya Sako, Hiroyuki Nakase, Shoichiro Kawaguchi, Fumihiko Nisimura, Junichi Yamao, Hiroaki Naritomi, Tooru Inoue, Hiroshi Abe, Akifumi Suzuki, Tatsuya Ishikawa, Yoshinori Akiyama, Toshihiko Suenaga, Miki Fujimura, Shinji Nagahiro, Masaaki Uno, Kyoko Nishi, Junichiro Satomi, Yoshikazu Okada, Akiji Kawashima, Kohji Yamaguchi, Yukiko Tsutsumi

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Abstract

BACKGROUND AND PURPOSE-: About one half of those who develop adult-onset moyamoya disease experience intracranial hemorrhage. Despite the extremely high frequency of rebleeding attacks and poor prognosis, measures to prevent rebleeding have not been established. The purpose of this study is to determine whether extracranial-intracranial bypass can reduce incidence of rebleeding and improve patient prognosis. METHODS-: This study was a multicentered, prospective, randomized, controlled trial conducted by 22 institutes in Japan. Adult patients with moyamoya disease who had experienced intracranial hemorrhage within the preceding year were given either conservative care or bilateral extracranial-intracranial direct bypass and were observed for 5 years. Primary and secondary end points were defined as all adverse events and rebleeding attacks, respectively. RESULTS-: Eighty patients were enrolled (surgical, 42; nonsurgical, 38). Adverse events causing significant morbidity were observed in 6 patients in the surgical group (14.3%) and 13 patients in the nonsurgical group (34.2%). Kaplan-Meier survival analysis revealed significant differences between the 2 groups (3.2%/y versus 8.2%/y; P=0.048). The hazard ratio of the surgical group calculated by Cox regression analysis was 0.391 (95% confidence interval, 0.148-1.029). Rebleeding attacks were observed in 5 patients in the surgical group (11.9%) and 12 in the nonsurgical group (31.6%), significantly different in the Kaplan-Meier survival analysis (2.7%/y versus 7.6%/y; P=0.042). The hazard ratio of the surgical group was 0.355 (95% confidence interval, 0.125-1.009). CONCLUSIONS-: Although statistically marginal, Kaplan-Meier analysis revealed the significant difference between surgical and nonsurgical group, suggesting the preventive effect of direct bypass against rebleeding.

Original languageEnglish
Pages (from-to)1415-1421
Number of pages7
JournalStroke
Volume45
Issue number5
DOIs
Publication statusPublished - 2014 May

Keywords

  • Cerebral revascularization
  • Hemorrhage
  • Moyamoya disease

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

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    Miyamoto, S., Yoshimoto, T., Hashimoto, N., Okada, Y., Tsuji, I., Tominaga, T., Nakagawara, J., Takahashi, J. C., Yamada, K., Tomata, Y., Fukui, T., Fukuuchi, Y., Ohmoto, T., Kuwabara, Y., Nagata, I., Ono, J., Machida, T., Sakakibara, R., Yamane, K., ... Tsutsumi, Y. (2014). Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: Results of the Japan adult moyamoya trial. Stroke, 45(5), 1415-1421. https://doi.org/10.1161/STROKEAHA.113.004386