Comparison of outcomes after direct extracranial-to-intracranial bypass for moyamoya disease and non-moyamoya pathology: A systematic review and meta-analysis.
Noel F Manalil, Teja R Buddhavarapu, Kyle Sporn et al.
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In 30 seconds
This systematic review and meta-analysis compared direct extracranial-to-intracranial (EC-IC) bypass outcomes in adults with moyamoya disease or syndrome (MMD) versus non-moyamoya steno-occlusive disease, mainly intracranial atherosclerotic disease and carotid occlusion. Seventeen studies included 1,354 patients and 1,451 hemispheres. Pooled analyses found no significant group differences in graft patency, postoperative stroke, intracranial hemorrhage, or hyperperfusion syndrome. For graft patency, the odds ratio was 0.81 (95% CI 0.54-1.21), with no detected heterogeneity (I2 = 0%).
Key findings
- Graft patency did not differ significantly between MMD and non-MMD groups (OR 0.81, 95% CI 0.54-1.21; I2 = 0%).
- Postoperative stroke rates showed no significant group difference (OR 0.68, 95% CI 0.33-1.41; I2 = 23%).
- No significant differences were found for intracranial hemorrhage (OR 1.46, 95% CI 0.34-6.26; I2 = 61.4%) or hyperperfusion syndrome (OR 1.69, 95% CI 0.67-4.26; I2 = 0%).
Why it matters
The findings suggest that reported technical and postoperative outcomes after direct EC-IC bypass were broadly similar across these indications. This comparison may help frame discussions of bypass outcomes in different steno-occlusive conditions, while the absence of significant differences should not be interpreted as proof of equivalence, particularly given the uncertainty in some estimates.
What to keep in mind
The review calls for larger multicenter cohorts, standardized techniques, and consistent outcome reporting to confirm the results; heterogeneity for intracranial hemorrhage was substantial (I2 = 61.4%).