Five-Year Stroke Risk and Its Predictors in Asymptomatic Moyamoya Disease: Asymptomatic Moyamoya Registry (AMORE)

Author:

Kuroda Satoshi1ORCID,Yamamoto Shusuke1,Funaki Takeshi2ORCID,Fujimura Miki3ORCID,Kataoka Hiroharu4ORCID,Hishikawa Tomohito5,Takahashi Jun6ORCID,Endo Hidenori7ORCID,Nariai Tadashi8ORCID,Osato Toshiaki9,Saito Nobuhito10,Sato Norihiro11,Hori Emiko1ORCID,Ito Yoichi M.12ORCID,Miyamoto Susumu2ORCID,Inaji Motoki,Morita Kenichi,Maruyama Daisuke,Nakagawara Jyoji,Hashimura Naoki,Hamano Eika,Iihara Koji,Hashimoto Nobuo,Honjo Kaori,Nakamura Hirohiko,Kashiwazaki Daina,Imai Hideaki,Miyawaki Satoru,Hongo Hiroki,Yoshida Kazumichi,Kikuchi Takayuki,Mineharu Yohei,Isozaki Makoto,Kikuta Kenichiro,Araki Yoshio,Kanamori Fumiaki,Date Isao,Ono Junichi,Machida Toshio,Mase Mitsuhito,Katano Hiroyuki,Yamaguchi Koji,Kawamata Takakazu,Tominaga Teiji,Uchino Haruto,Tokairin Kikutaro,Ito Masaki,Houkin Kiyohiro,Chida Kohei,Ogasawara Kuniaki,Nagata Izumi,Horie Nobutaka,Oka Hidehiro,Kumabe Toshihiro,Itoh Yoshiaki,Abe Takato,Oki Koichi,Takahashi Shinichi,Suzuki Norihiro

Affiliation:

1. Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan (S.K., S.Y., E.H.).

2. Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (T.F., S.M.).

3. Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan (M.F.).

4. Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.K.).

5. Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Japan (T.H.).

6. Department of Neurosurgery, Kindai University School of Medicine, Sayama, Japan (J.T.).

7. Department of Neurosurgery, Kohnan Hospital, Sendai, Japan (H.E.).

8. Department of Neurosurgery, Tokyo Medical and Dental University, Japan (T.N.).

9. Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan (T.O.).

10. Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Japan (N. Saito).

11. Clinical Research and Medical Innovation Center (N. Sato), Hokkaido University Hospital, Sapporo, Japan.

12. Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care (Y.M.I.), Hokkaido University Hospital, Sapporo, Japan.

Abstract

Background: Long-term outcomes are unknown in patients with asymptomatic moyamoya disease. In this report, we aimed to clarify their 5-year risk of stroke and its predictors. Methods: We are conducting a multicenter, prospective cohort study (Asymptomatic Moyamoya Registry) in Japan. Participants were eligible if they were 20 to 70 years, had bilateral or unilateral moyamoya disease, experienced no episodes suggestive of TIA and stroke; and were functionally independent (modified Rankin Scale score 0–1). Demographic and radiological information was collected at enrollment. In this study, they are still followed up for 10 years. In this interim analysis, we defined the primary end point as a stroke occurring during a 5-year follow-up period. Independent predictors for stroke were also determined, using a stratification analysis method. Results: Between 2012 and 2015, we enrolled 109 patients, of whom 103 patients with 182 involved hemispheres completed the 5-year follow-up. According to the findings on DSA and MRA, 143 hemispheres were judged as moyamoya disease and 39 hemispheres as questionable manifestations (isolated middle cerebral artery stenosis). The patients with questionable hemispheres were significantly older, more often male, and more frequently had hypertension than those with moyamoya hemisphere. Moyamoya hemispheres developed 7 strokes, including 6 hemorrhagic and 1 ischemic stroke, during the first 5 years. The annual risk of stroke was 1.4% per person, 0.8% per hemisphere, and 1.0% per moyamoya hemisphere. Independent predictor for stroke was Grade-2 choroidal anastomosis (hazard ratio, 5.05 [95% CI, 1.24–20.6]; P =0.023). Furthermore, microbleeds (hazard ratio, 4.89 [95% CI, 1.13-21.3]; P =0.0342) and Grade-2 choroidal anastomosis (hazard ratio, 7.05 [95% CI, 1.62–30.7]; P =0.0093) significantly predicted hemorrhagic stroke. No questionable hemispheres developed any stroke. Conclusions: The hemispheres with asymptomatic moyamoya disease may carry a 1.0% annual risk of stroke during the first 5 years, the majority of which are hemorrhagic stroke. Grade-2 choroidal anastomosis may predict stroke, and the microbleeds and Grade-2 choroidal anastomosis may carry the risk for hemorrhagic stroke. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: UMIN000006640.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3