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 Ivan, Venkatesh Aiyagari, James R. Sagar, Nancy Hantler, Lina Shinawi, John J. Lee, Hussain Jafri, Robert L. Grubb, J. Philip Miller, Ralph G. Dacey

Research output: Contribution to journalArticle

8 Citations (Scopus)

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

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Natural History
Hemodynamics
Stroke
Oxygen
Hemorrhage
Selection Bias
Positron-Emission Tomography
Longitudinal Studies
Cohort Studies
Population

Keywords

  • arterial occlusive disease
  • atherosclerosis
  • natural history

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Baseline Hemodynamic Impairment and Future Stroke Risk in Adult Idiopathic Moyamoya Phenomenon : Results of a Prospective Natural History Study. / Derdeyn, Colin P.; Zipfel, Gregory J.; Zazulia, Allyson R.; Davis, Patricia H.; Prabhakaran, Shyam; Ivan, Cristina; Aiyagari, Venkatesh; Sagar, James R.; Hantler, Nancy; Shinawi, Lina; Lee, John J.; Jafri, Hussain; Grubb, Robert L.; Miller, J. Philip; Dacey, Ralph G.

In: Stroke, Vol. 48, No. 4, 01.04.2017, p. 894-899.

Research output: Contribution to journalArticle

Derdeyn, CP, Zipfel, GJ, Zazulia, AR, Davis, PH, Prabhakaran, S, Ivan, C, Aiyagari, V, Sagar, JR, Hantler, N, Shinawi, L, Lee, JJ, Jafri, H, Grubb, RL, Miller, JP & Dacey, RG 2017, 'Baseline Hemodynamic Impairment and Future Stroke Risk in Adult Idiopathic Moyamoya Phenomenon: Results of a Prospective Natural History Study', Stroke, vol. 48, no. 4, pp. 894-899. https://doi.org/10.1161/STROKEAHA.116.014538
Derdeyn, Colin P. ; Zipfel, Gregory J. ; Zazulia, Allyson R. ; Davis, Patricia H. ; Prabhakaran, Shyam ; Ivan, Cristina ; Aiyagari, Venkatesh ; Sagar, James R. ; Hantler, Nancy ; Shinawi, Lina ; Lee, John J. ; Jafri, Hussain ; Grubb, Robert L. ; Miller, J. Philip ; Dacey, Ralph G. / Baseline Hemodynamic Impairment and Future Stroke Risk in Adult Idiopathic Moyamoya Phenomenon : Results of a Prospective Natural History Study. In: Stroke. 2017 ; Vol. 48, No. 4. pp. 894-899.
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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.",
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AU - Prabhakaran, Shyam

AU - Ivan, Cristina

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AU - Sagar, James R.

AU - Hantler, Nancy

AU - Shinawi, Lina

AU - Lee, John J.

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