This protocol covers the management of adult patients (age 18 years or older) with Moyamoya syndrome who have a symptomatic ischaemic presentation — either transient ischaemic attack (TIA) or ischaemic stroke — and who do not have a haemorrhagic presentation.
Patients are considered symptomatic when presenting with TIA or ischaemic stroke. In adults with Moyamoya syndrome, the disease predominantly manifests as ischaemic events. This protocol applies specifically to the non-haemorrhagic ischaemic presentation.
For adult patients without haemorrhagic presentation, the cornerstone of management involves long-term antiplatelet therapy aimed at reducing the risk of embolic strokes. The specific agent selection and regimen details are available in the full structured protocol.
DOI: 10.1177/23969873221144089
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 patients with non-haemorrhagic MMA, we suggest the use of long-term antiplatelet therapy to reduce the risk of embolic strokes without an increase in haemorrhagic strokes.
Evaluating the type of antiplatelet drugs, the most commonly used agents in the studies included in this analysis were aspirin, clopidogrel or cilostazol as monotherapy, with only a minority of patients receiving dual antiplatelet therapy.
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