Sex differences in clinical presentation and treatment outcomes in Moyamoya disease.
BACKGROUND
Moyamoya (MM) disease is an idiopathic steno-occlusive angiopathy occurring more frequently in females.


OBJECTIVE
To evaluate sex differences in preoperative symptoms and treatment outcomes after revascularization surgery.


METHODS
We analyzed 430 MM disease patients undergoing 717 revascularization procedures spanning 19 years (1991-2010) and compared gender differences in preoperative symptoms and long-term outcomes after surgical revascularization.


RESULTS
A total of 307 female and 123 male patients (ratio, 2.5:1) with a mean age of 31.0 ± 16.7 years and adults-to-children ratio of 2.5:1 underwent 717 revascularization procedures. Female patients were more likely to experience preoperative transient ischemic attacks (odds ratio: 2.1, P = .001) and less likely to receive a diagnosis of unilateral MM disease (odds ratio: 0.6, P = .04). No association was observed between sex and risk of preoperative ischemic or hemorrhagic stroke. There was no difference in neurological outcome because both male and female patients experienced significant improvement in the modified Rankin Scale score after surgery (P < .0001). On Kaplan-Meier survival analysis, 5-year cumulative risk of adverse postoperative events despite successful revascularization was 11.4% in female vs 5.3% in male patients (P = .05). In multivariate Cox proportional hazards analysis, female sex trended toward an association with adverse postoperative events (hazard ratio: 1.9, P = .14).


CONCLUSIONS
Female patients are more susceptible to the development of preoperative transient ischemic attack and may be at higher risk of adverse postoperative events despite successful revascularization. There is, however, no sex difference in neurological outcome because patients of both sexes experience significant improvement in neurological status with low risk of the development of future ischemic events after surgical revascularization.
Department of Neurosurgery, Stanford Stroke Center, Stanford University School of Medicine, California 94305-5487, USA.
Nadia
N
Khan
Achal S
AS
Achrol
Raphael
R
Guzman
Terry C
TC
Burns
Robert
R
Dodd
Teresa
T
Bell-Stephens
Gary K
GK
Steinberg
D000328:Adult; D002548:Cerebral Revascularization; D002648:Child; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009072:Moyamoya Disease / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012727:Sex Characteristics; D016896:Treatment Outcome