title: Effects of Surgery and Antiplatelet Therapy in Ten-Year Follow-Up from the Registry Study of Research Committee on Moyamoya Disease in Japan.
abstract: BACKGROUND
  Despite the common practice of surgery and antiplatelet therapy for the prevention of recurrent stroke in patients with moyamoya disease, the benefit of these treatments is controversial. We analyzed the stroke recurrence rate in the Registry Study of Research Committee on Moyamoya Disease in Japan funded by the Health, Labor and Welfare Ministry of Japan.
  
  
  METHODS
  An annual follow-up study of the registered cases was continued for 10 years. The rate of recurrent stroke, including cerebral infarction and hemorrhage but not transient ischemic attack and seizure, was evaluated with Kaplan-Meier analysis.
  
  
  RESULTS
  The proportion of childhood-onset cases decreased in recently registered cases (within 10 years, n = 541) compared to remote cases (> 10 years, n = 735). Among types at disease onset in adult-onset cases, intracerebral hemorrhage decreased recently. In recent cases, the rate of subsequent cerebral hemorrhage was much higher in the hemorrhagic group (10.9 ± 3.3%/5 years) than in the ischemic group (2.0 ± .9%/5 years). The recurrence rate of cerebral infarction was lower in the surgery group (1.8 ± .9%/5 years) than in the nonsurgery group (3.8 ± 2.2%/5 years). In the adult-onset ischemic group, the proportion of surgically treated patients increased and their recurrence rate was lower than that of nonsurgery patients. In the ischemic group, the rate of cerebral infarction was not significantly different between the antiplatelet subgroup and the non-antiplatelet subgroup, whereas the rate of cerebral hemorrhage was higher in the non-antiplatelet subgroup than in the antiplatelet subgroup.
  
  
  CONCLUSIONS
  Our results suggest revascularization surgery may suppress recurrent ischemic attacks in patients with moyamoya disease.
authors.affiliation: Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Oki
authors.affiliation: Department of Neurology, Keio University School of Medicine, Tokyo, Japan; Department of Neurology, Osaka City University Graduate School of Medicine, Osaka, Japan. Electronic address: y-itoh@med.osaka-cu.ac.jp.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Itoh
authors.affiliation: Department of Neurosurgery, Toyama University, Toyma, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
authors.affiliation: Department of Neurosurgery, Hokkaido University, Sapporo, Japan.
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
authors.affiliation: Department of Neurosurgery, Tohoku University, Sendai, Japan.
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
authors.affiliation: Department of Neurosurgery, Kyoto University, Kyoto, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hashimoto
authors.affiliation: Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Suzuki
mesh_terms: D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery; D002548:Cerebral Revascularization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D012042:Registries; D055502:Secondary Prevention; D020521:Stroke / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Stroke prevention; cerebral infarction; intracerebral hemorrhage; revascularization; thrombosis