علاج متلازمة مويامويا لدى البالغين المصابين بسكتة دماغية إقفارية أو نوبة إقفارية عابرة

Patients were considered symptomatic when presenting with TIA, ischaemic or haemorrhagic stroke, headache, movement disorders or cognitive disturbances.

Indeed, the expression of the MMA is mainly ischaemic in children, whereas it is also characterised by cerebral haemorrhage in adults.

In adult MMA patients with ischaemic presentation, we suggest that revascularization surgery should be considered in case of clinical symptoms and/or imaging markers of haemodynamic impairment.

In adult MMA patients, we suggest direct/combined revascularization instead of indirect strategies for reducing risk of stroke.

In patients with MMA, we suggest waiting 6–12 weeks from an acute cerebrovascular event before performing surgery for MMA patients, to reduce the rate of postoperative complications.

In patients with MMA, we suggest avoiding trigger factors such as dehydration, fever, and hyperventilation as well as hypotension when waiting for surgery.

For patients with MMA, we suggest that, during bypass surgery continuation of antiplatelet treatment as monotherapy (aspirin) is safe.

In case of dual antiplatelet therapy (aspirin + clopidogrel or other antiplatelets), we suggest stopping clopidogrel, or the other second antiplatelet therapy, for 7 days before surgery.

However, in case of discontinuation, we suggest restarting antiplatelet therapy 1–7 days after surgery, depending on the post-surgery CT scan.

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