title: Incidence and clinical features of disease progression in adult moyamoya disease.
abstract: OBJECTIVE
  The progression of occlusive lesions in the major intracranial arteries was believed to be very rare in adult patients with moyamoya disease. The present study aims to clarify the incidence and clinical features of disease progression in adult moyamoya disease.
  
  
  METHODS
  For the past 15 years, 120 adult Japanese patients were diagnosed with moyamoya disease. Of these, 63 patients were enrolled in this historical prospective cohort study on a total of 86 nonoperated hemispheres. All were followed up with a mean period of 73.6 months. MRI and magnetic resonance angiography were repeated every 6 to 12 months, and cerebral angiography was performed when disease progression was suspected on MRI and magnetic resonance angiography.
  
  
  RESULTS
  Disease progression occurred in 15 of 86 nonoperated hemispheres (17.4% per hemisphere) or in 15 of 63 patients (23.8% per patient) during the follow-up period. Occlusive arterial lesions progressed in both anterior and posterior circulations, in both symptomatic and asymptomatic patients, and in both bilateral and unilateral types. Eight of 15 patients developed ischemic or hemorrhagic events in relation to disease progression. Multivariate analysis revealed that the odds ratio conferred by a male patient was 0.20 (95% CI, 0.04 to 0.97).
  
  
  CONCLUSIONS
  The incidence of disease progression in adult moyamoya disease is much higher than recognized before, and female patients may be at higher risk for it than male patients. Careful follow-up would be essential to prevent additional stroke occurrence in medically treated adult patients with moyamoya disease, even if they are asymptomatic or are diagnosed as having unilateral moyamoya disease.
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. skuroda@med.hokudai.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
authors.forename: Rina
authors.initials: R
authors.lastname: Nanba
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hokari
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Iwasaki
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D002533:Cerebral Angiography / Q000379:methods; D002536:Cerebral Arteries / Q000473:pathology; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D015999:Multivariate Analysis; D016017:Odds Ratio; D013997:Time Factors; D014057:Tomography, X-Ray Computed