Outcomes and Complications of Endovascular Treatment in Patients with Moyamoya Disease: A Systematic Review

Takahiro Tsuchiya; Yudai Hirano; Satoru Miyawaki; Satoshi Koizumi; Shotaro Ogawa; Seiei Torazawa; Hiroki Hongo; Hideaki Ono; Nobuhito Saito

doi:10.1016/j.wneu.2025.123783

Outcomes and Complications of Endovascular Treatment in Patients with Moyamoya Disease: A Systematic Review

World Neurosurg. 2025 Mar 6:196:123783. doi: 10.1016/j.wneu.2025.123783. Online ahead of print.

Authors

Takahiro Tsuchiya¹, Yudai Hirano¹, Satoru Miyawaki², Satoshi Koizumi¹, Shotaro Ogawa¹, Seiei Torazawa¹, Hiroki Hongo¹, Hideaki Ono¹, Nobuhito Saito¹

Affiliations

¹ Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
² Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. Electronic address: smiya-nsu@m.u-tokyo.ac.jp.

PMID: 39947318
DOI: 10.1016/j.wneu.2025.123783

Abstract

Objective: The mainstream approach for preventing cerebrovascular events in hemorrhagic or ischemic moyamoya disease (MMD) is surgical revascularization, and the indications for endovascular treatment (EVT) for MMD are limited. This systematic review aimed to evaluate the outcomes and complications associated with EVT in patients with MMD.

Methods: A comprehensive search was conducted in June 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the PubMed, Cochrane Library, and Web of Science databases, for patients with MMD treated with EVT.

Results: Seventy-eight studies including 287 patients treated with EVT were identified. Target diseases included 255 aneurysms, 23 intracranial arterial stenoses, 4 extracranial arterial stenoses, 3 large vessel occlusioniks, and 2 dural arteriovenous fistulas. The outcomes of EVT for aneurysms in patients with MMD were comparable to those in patients without MMD. A significant association was observed between distal aneurysms and treatment failure (P < 0.001). The risk of rerupture in the group that received conservative treatment for ruptured aneurysms was higher than that in the group that received radical treatment (P < 0.001). EVT for intracranial arterial stenosis carried a higher risk of recurrence, while that risk did not differ between the angioplasty and stent placement groups, with a median recurrence-free survival of 4 and 3.5 months, respectively (P = 0.668).

Conclusions: For the patients with MMD, EVT of distal aneurysms would likely be unsuccessful because of the access difficulties. Furthermore, EVT for intracranial arterial stenosis often results in unsatisfactory treatment and has limited indications owing to the risk of complications.

Keywords: Complication; Embolization; Endovascular; Moyamoya disease.