title: Baseline Hemodynamic Impairment and Future Stroke Risk in Adult Idiopathic Moyamoya Phenomenon: Results of a Prospective Natural History Study.
abstract: The purpose was to test the hypothesis that increased oxygen extraction fraction (OEF), a marker of severe hemodynamic impairment measured by positron emission tomography, is an independent risk factor for subsequent ischemic stroke in this population.
  
  
  
  Adults with idiopathic moyamoya phenomena were recruited between 2005 and 2012 for a prospective, multicenter, blindly adjudicated, longitudinal cohort study. Measurements of OEF were obtained on enrollment. Subjects were followed up for the occurrence of ipsilateral ischemic stroke at 6-month intervals. Patients were censored at the time of surgical revascularization or at last follow-up. The primary analysis was time to ischemic stroke in the territory of the occlusive vasculopathy.
  
  
  
  Forty-nine subjects were followed up during a median of 3.7 years. One of 16 patients with increased OEF on enrollment had an ischemic stroke and another had an intraparenchymal hemorrhage. Three of 33 patients with normal OEF had an ischemic stroke. On a per-hemisphere basis, 21 of 79 hemispheres with moyamoya vasculopathy had increased OEF at baseline. No ischemic strokes and one hemorrhage occurred in a hemisphere with increased OEF (n=21). Sixteen patients (20 hemispheres), including 5 with increased OEF at enrollment, were censored at a mean of 5.3 months after enrollment for revascularization surgery.
  
  
  
  The risk of new or recurrent stroke was lower than expected. The low event rate, low prevalence of increased OEF, and potential selection bias introduced by revascularization surgery limit strong conclusions about the association of increased OEF and future stroke risk.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00629915.
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.). colin-derdeyn@uiowa.edu.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Derdeyn
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Zipfel
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: Allyson R
authors.initials: AR
authors.lastname: Zazulia
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Davis
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: Cristina S
authors.initials: CS
authors.lastname: Ivan
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Aiyagari
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: James R
authors.initials: JR
authors.lastname: Sagar
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: Nancy
authors.initials: N
authors.lastname: Hantler
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: Lina
authors.initials: L
authors.lastname: Shinawi
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: John J
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: Hussain
authors.initials: H
authors.lastname: Jafri
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: Robert L
authors.initials: RL
authors.lastname: Grubb
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: J Philip
authors.initials: JP
authors.lastname: Miller
authors.affiliation: From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
authors.forename: Ralph G
authors.initials: RG
authors.lastname: Dacey
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D000069336:Neurovascular Coupling; D010100:Oxygen / Q000378:metabolism; D049268:Positron-Emission Tomography / Q000379:methods*; D012008:Recurrence; D012307:Risk Factors; D016037:Single-Blind Method; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology
chemical_list: D010100:Oxygen
keywords: arterial occlusive disease; atherosclerosis; natural history