Outcomes of Medical Management Alone for Adult Patients with Cerebral Misery Perfusion Due to Ischemic Moyamoya Disease |
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| Affiliation: | 1. Department of Neurosurgery, Iwate Medical University, Japan;2. Institute for Biomedical Sciences, Iwate Medical University, Japan;1. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, Fengtai district, Beijing 100070, China;2. Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing 100070, China;3. The George Institute for Global Health at Peking University Health Science Center, Beijing, China;4. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia;5. Department of Ultrasound, Huaian Hospital of Huaian City, Huaian, Jiangsu, China;1. Department of Radiology, Mayo Clinic;2. Department of Quantitative Health Sciences, Mayo Clinic;3. Department of Neurology, Mayo Clinic;4. Department of Quantitative Health Sciences, Mayo Clinic;1. Stroke Unit. Department of Neurology. Hospital UniversitarI Doctor Josep Trueta de Girona. Girona Biomedical Research Institute (IDIBGI). Girona, Spain;2. Statistical and Methodological Advisory Unit, Girona Biomedical Research Institute (IDIBGI), Girona, Spain;3. Cerebrovascular Pathology Research Group, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Girona, Spain;1. School of Industrial Technology, Advanced Institute of Industrial Technology, Tokyo Metropolitan Public University Corporation, Tokyo, Japan;2. Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan;4. Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Aichi, Japan;5. Department of Community Mental Health & Low, National Center of Neurology and Psychiatry, Tokyo, Japan;6. Department of Dementia and Neuropsychology, Advanced Institute of Industrial Technology, Tokyo Metropolitan Public University Corporation, Tokyo, Japan;7. Department of Cognition and Behavioral Science, Nagoya University Graduate School of Medicine, Aichi, Japan;1. University of Iowa Carver College of Medicine, United States;2. University of Iowa, Neurology Residency, United States;3. University of Iowa, Neuroradiology Department, United States;4. University of Iowa, Neurology Department, 200 Hawkins Drive, Iowa City IA 52242, United States;5. Iowa City VA Medical Center, United States |
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| Abstract: | ObjectivesAlthough revascularization surgery is recommended for adult patients with moyamoya disease (MMD) who present with ischemic symptoms due to hemodynamic compromise, the clinical course of such patients who are treated with medical management alone remains unclear. Here, we report outcomes of adult patients with cerebral misery perfusion due to ischemic MMD who received medical management alone.Materials and MethodsWe prospectively followed up patients who showed misery perfusion in the symptomatic cerebral hemisphere on 15O gas positron emission tomography (PET) and received strict medical management alone after refusing revascularization surgery.ResultsOf 57 patients who showed symptomatic misery perfusion on 15O gas PET, three (5%) were included into the present study. Two of these patients suffered further ischemic events at 7 and 8 months after inclusion, after which, their modified Rankin disability scale scores deteriorated. In the remaining patient, fatal intracerebral hemorrhage developed at 10 months after inclusion.ConclusionsThese findings suggest that receiving medical management alone is associated with considerably poor outcomes for adult patients with cerebral misery perfusion due to ischemic MMD. |
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