Muengtaweepongsa S, Panpattanakul V. Is medical management useful in Moyamoya disease? World J Clin Cases 2024; 12(3): 466-473 [PMID: 38322475 DOI: 10.12998/wjcc.v12.i3.466]
Corresponding Author of This Article
Sombat Muengtaweepongsa, MD, Professor, Center of Excellence in Stroke, Division of Neurology, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, No. 99/209 Paholyothin Rd., Klonglaung 12120, Pathum Thani, Thailand. musombat@tu.ac.th
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sombat Muengtaweepongsa, Center of Excellence in Stroke, Division of Neurology, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, Klonglaung 12120, Pathum Thani, Thailand
Vatcharasorn Panpattanakul, Division of Neurology, Department of Internal Medicine, School of Medicine, University of Phayao, Phayao 56000, Thailand
Co-first authors: Sombat Muengtaweepongsa and Vatcharasorn Panpattanakul.
Author contributions: Muengtaweepongsa S and Panpattanakul V contributed equally to this work; Muengtaweepongsa S contributed to conception and design of the work, drafting and critical revision of the article, and gave final approval; Panpattanakul V contributed to conception and design of the work, data collection, drafting and critical revision of the article.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sombat Muengtaweepongsa, MD, Professor, Center of Excellence in Stroke, Division of Neurology, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, No. 99/209 Paholyothin Rd., Klonglaung 12120, Pathum Thani, Thailand. musombat@tu.ac.th
Received: October 13, 2023 Peer-review started: October 13, 2023 First decision: November 22, 2023 Revised: November 24, 2023 Accepted: January 5, 2024 Article in press: January 5, 2024 Published online: January 26, 2024
Abstract
Moyamoya disease (MMD), characterized by progressive internal carotid artery stenosis and collateral vessel formation, prompts cerebral perfusion complications and is stratified into idiopathic and Moyamoya syndrome subtypes. A multifaceted approach toward MMD management addresses cerebral infarctions through revascularization surgery and adjunctive medical therapy, while also navigating risks such as intracranial hemorrhage and cerebral infarction resulting from arterial stenosis and fragile collateral vessels. Addressing antithrombotic management reveals a potential role for treatments like antiplatelet agents and anticoagulants, despite the ambiguous contribution of thrombosis to MMD-related infarctions and the critical balance between preventing ischemic events and averting hemorrhagic complications. Transcranial doppler has proven useful in thromboembolic detection, despite persisting challenges concerning the efficacy and safety of antithrombotic treatments. Furthermore, antihypertensive interventions aim to manage blood pressure meticulously, especially during intracerebral hemorrhage, with recommendations and protocols varying based on the patient’s hypertension status. Additionally, lipid-lowering therapeutic strategies, particularly employing statins, are appraised for their possible beneficial role in MMD management, even as comprehensive data from disease-specific clinical trials remains elusive. Comprehensive guidelines and protocols to navigate the multifaceted therapeutic avenues for MMD, while maintaining a delicate balance between efficacy and safety, warrant further meticulous research and development. This protocol manuscript seeks to elucidate the various aspects and challenges imbued in managing and navigating through the complex landscape of MMD treatment.
Core Tip: Moyamoya disease (MMD) involves progressive arterial stenosis, leading to cerebral infarctions and hemorrhages. Key treatments include revascularization surgery and supplementary medical therapy. Antithrombotic management, crucial for ischemic stroke prevention in MMD, requires a careful balance due to bleeding risks. Understanding cerebral infarction pathways, involving hemodynamic impairment and thromboembolism, is essential. Transcranial doppler is useful for emboli detection and screening. Antiplatelet therapy, especially Acetylsalicylic acid, is common, but its efficacy varies. Antihypertensive management is recommended during initial hemorrhage phases, while lipid-lowering strategies like statins show potential but need more research for specific guidelines in MMD.
