Outcomes of medical management alone for adult patients with cerebral misery perfusion due to ischemic moyamoya disease

Objectives: Although revascularization surgery is recommended for adult patients with moyamoya disease (MMD) who present with ischemic symptoms due to hemodynamic compromise, the clinical course of such patients who are treated with medical management alone remains unclear. Here, we report outcomes of adult patients with cerebral misery perfusion due to ischemic MMD who received medical management alone. Materials and Methods: We prospectively followed up patients who showed misery perfusion in the symptomatic cerebral hemisphere on 15 O gas positron emission tomography (PET) and received strict medical management alone after refusing revascularization surgery. Results: Of 57 patients who showed symptomatic misery perfusion on 15 O gas PET, three (5%) were included into the present study. Two of these patients suffered further ischemic events at 7 and 8 months after inclusion, after which, their modified Rankin disability scale scores deteriorated. In the remaining patient, fatal intracerebral hemorrhage developed at 10 months after inclusion. Conclusions: These findings suggest that receiving medical management alone is associated with considerably poor outcomes for adult patients with cerebral misery perfusion due to ischemic MMD.(c) 2022 Elsevier Inc. All rights reserved.