Neurosurgical Review

, Volume 37, Issue 4, pp 579–583 | Cite as

Endovascular treatment of symptomatic moyamoya

  • Bradley A. Gross
  • Ajith J. Thomas
  • Kai U. Frerichs
Review

Abstract

Moyamoya is a rare though important source of neurological morbidity as a result of both ischemic and hemorrhagic sequelae. Although a litany of series detailing the endovascular management of cerebral ischemia is present in the literature, only a paucity of such reports exists for moyamoya. A systematic review of the literature was performed for patients with moyamoya managed with endovascular techniques in addition to the contribution of an additional case managed at our institution. We evaluated treatment approach (angioplasty and/or stent), complications, and both angiographic and clinical outcomes at last follow-up. Results from a total of 28 endovascular procedures were collected (11 stenting, 17 angioplasty alone). Procedural success, defined as a lack of both angiographic and clinical recurrence at follow-up, was achieved after seven procedures (25 %). This rate did not significantly differ between disease type (moyamoya disease vs moyamoya syndrome, p = 1.0) and treatment approach (angioplasty alone vs stenting, p = 1.0). The overall monthly angiographic and clinical recurrence rates were 9.3 and 8.0 %, respectively. Clinically devastating intracerebral hemorrhage was seen after two procedures (7 %), and in an additional three procedures, the treated vessel could not be effectively dilated (11 %). There is no evidence that angioplasty or stenting improves the natural history of moyamoya. Both are associated with significant rates of early angiographic and/or clinical recurrence of symptoms. Taken with the risk of procedural complications, the current limited data should advise against attempted endovascular treatment of moyamoya.

Keywords

Moyamoya Ischemia Angioplasty Stent Wingspan Endovascular 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Bradley A. Gross
    • 1
  • Ajith J. Thomas
    • 2
  • Kai U. Frerichs
    • 1
  1. 1.Department of Neurological SurgeryBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA

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