title: Surgical outcomes and predictors of stroke in a North American white and African American moyamoya population.
abstract: BACKGROUND
  The majority of moyamoya surgical series have been confined to Asian and pediatric populations. Few have studied demographics, risk factors, and outcomes in adult North American populations.
  
  
  OBJECTIVE
  To examine outcomes after revascularization for moyamoya in white and African American adults and to assess for predictors of recurrent stroke.
  
  
  METHODS
  A retrospective review of 75 non-Asian patients undergoing 110 procedures at the Mayo Clinic was performed. Demographics, known moyamoya associations, cerebrovascular risk factors, and autoimmune diseases were recorded. Primary outcomes for vascular events were assessed with Kaplan-Meier analysis. Fisher exact methods were used to evaluate for associations with recurrent events.
  
  
  RESULTS
  Mean age was 42 years, and mean follow-up was 47 months. Seventy-one of the 75 patients were white. The majority had bilateral disease (n = 49). Perioperative ischemic events occurred in 5 patients (4.5%). The 5- and 10-year event rates were 5.8% and 9.9%. Significant associations were found with a history of thyroid disease (P = .05) and recurrent stroke. A trend was also found between hypertension and autoimmune disease with recurrent stroke.
  
  
  CONCLUSIONS
  Outcomes were favorable with revascularization in this subset with moyamoya. A significant association between a history of thyroid disease and recurrent stroke was found. Additionally, high prevalences of autoimmune disease, hypertension, and thyroid disease were found in our cohort, suggesting that they may play a role in the pathophysiology and progression of moyamoya disease in this population. A new classification for moyamoya is proposed based on these data.
authors.affiliation: *Department of Neurosurgery, Mayo Clinic Rochester, Rochester, Minnesota; ‡Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Mallory
authors.forename: Regina S
authors.initials: RS
authors.lastname: Bower
authors.forename: Macaulay E
authors.initials: ME
authors.lastname: Nwojo
authors.forename: Philipp
authors.initials: P
authors.lastname: Taussky
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Wetjen
authors.forename: Thais C
authors.initials: TC
authors.lastname: Varzoni
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Hanel
authors.forename: Fredric B
authors.initials: FB
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology*; D002548:Cerebral Revascularization / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D044465:White People; D055815:Young Adult