Is medical management useful in Moyamoya disease?

Table 1 The antithrombotic treatment for Moyamoya disease

Antithrombotic treatment	Rationale
Single antiplatelet regimen [agents: ASA (50-325 mg) per day; clopidogrel (75 mg) per day; cilostazol (200 mg) per day]	Primary stroke prevention in embolic detection by TCD; Secondary stroke prevention
Dual antiplatelet regimen	No role
Anticoagulant	Contra-indicated
Thrombolysis	Use with caution

ASA: Acetylsalicylic acid; TCD: Transcranial doppler.

Table 2 Delineation of antihypertensive strategies in Moyamoya disease

Antihypertensive treatment	The rationale of treatment in Moyamoya disease
Nicardipine 5-15 mg/h; Labetalol 10 mg IV over 1-2 min followed by infusion of 2-8 mg/min	The early stage of intracerebral hemorrhage
Angiotensin-converting enzyme inhibitors; Angiotensin receptor blockers; Calcium channel blockers (highly lipophilic); Diuretics	Presenting concurrent hypertension: primary and secondary prevention for cerebral ischemia or hemorrhage

Table 3 Analyzing lipid-lowering therapeutic interventions in Moyamoya disease

Lipid-lowering agent	Corresponding rationale in Moyamoya disease treatment
Statins	Addressing concurrent dyslipidemia (LDL > 100)
	Facilitating collateral development post-EDAS
Fibrate	Literature provides no extant findings

LDL: Low-density lipoprotein; EDAS: Encephaloduroarteriosynangiosis.