title: Revascularization of Moyamoya Angiopathy in Older Adults.
abstract: BACKGROUND
  Moyamoya angiopathy most often manifests in patients in the second and third decades of life. Although uncommon, it can also manifest later in life. We present our results in patients >50 years old with moyamoya angiopathy who were treated with surgical revascularization via either direct bypass or indirect bypass (encephaloduroarteriosynangiosis).
  
  
  METHODS
  A retrospective review was conducted to identify patients with moyamoya disease who were treated with surgical revascularization at our institution between 2002 and 2015. Outcomes and complications were analyzed.
  
  
  RESULTS
  We identified 33 patients with moyamoya angiopathy >50 years old (mean age 59.0 years ± 7.6) who were treated with surgical revascularization of 45 affected hemispheres. Of the affected hemispheres, 27 (60%) were treated with indirect bypasses and 18 (40%) were treated with direct bypasses. Neurologic complications occurred in 4 (12%) patients. The mean length of follow-up was 18.7 months ± 18.6; 4 patients were lost to follow-up. At last follow-up, 11 of 18 (61%) direct bypasses were patent. Treatment failed in 5 of 45 (11%) treated hemispheres (stroke in 2 and persistent transient ischemic attacks in 3). In terms of functional outcome at last follow-up, 16 of 29 (55%) patients were the same as before surgery, 10 (35%) were better, and 3 (10%) were worse (including 1 death).
  
  
  CONCLUSIONS
  Although uncommon, moyamoya angiopathy can manifest in older adults. Surgical revascularization is a reasonable treatment option with good functional outcomes and an acceptable complication rate.
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Williamson
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Adib A
authors.initials: AA
authors.lastname: Abla
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Zabramski
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@dignityhealth.org.
authors.forename: John E
authors.initials: JE
authors.lastname: Wanebo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002548:Cerebral Revascularization / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bypass; Complication; Elderly; Encephaloduroarteriosynangiosis; Moyamoya; Outcome; Stroke; Transient ischemic attack