Baseline Hemodynamic Impairment and Future Stroke Risk in Adult Idiopathic Moyamoya Phenomenon: Results of a Prospective Natural History Study

Colin P. Derdeyn, Gregory J. Zipfel, Allyson R. Zazulia, Patricia H. Davis, Shyam Prabhakaran, Cristina S. Ivan, Venkatesh Aiyagari, James R. Sagar, Nancy Hantler, Lina Shinawi, John J. Lee, Hussain Jafri, Robert L. Grubb, J. Philip Miller, Ralph G. Dacey

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Abstract

Background and Purpose-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. Methods-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. Results-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. Conclusions-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.

Original languageEnglish
Pages (from-to)894-899
Number of pages6
JournalStroke
Volume48
Issue number4
DOIs
StatePublished - Apr 1 2017

Keywords

  • arterial occlusive disease
  • atherosclerosis
  • natural history

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    Derdeyn, C. P., Zipfel, G. J., Zazulia, A. R., Davis, P. H., Prabhakaran, S., Ivan, C. S., Aiyagari, V., Sagar, J. R., Hantler, N., Shinawi, L., Lee, J. J., Jafri, H., Grubb, R. L., Miller, J. P., & Dacey, R. G. (2017). Baseline Hemodynamic Impairment and Future Stroke Risk in Adult Idiopathic Moyamoya Phenomenon: Results of a Prospective Natural History Study. Stroke, 48(4), 894-899. https://doi.org/10.1161/STROKEAHA.116.014538