Effects of antiplatelet therapy on reducing stroke risk in patients with moyamoya disease: the role of postcontrast MR vessel wall imaging.

OBJECTIVE

To evaluate the role of vessel wall enhancement in the efficacy of antiplatelet therapy (APT) on reducing the stroke risk in patients with Moyamoya disease (MMD) based on postcontrast MR vessel wall imaging.

METHODS

Consecutive patients with MMD underwent postcontrast MR vessel wall imaging and were divided into APT and non-APT groups according to the prescribed antiplatelet agents. Kaplan-Meier survival and Cox regression analyses were performed to determine the association between APT and stroke risk of patients with MMD, and subgroup analysis was performed to determine the role of vessel wall enhancement in reducing stroke risk after APT.

RESULTS

A total of 1262 patients (mean age: 42.6 ± 11.1 years) were finally included for analysis. Compared with patients without APT, those with APT were older (p = 0.023) and had a higher incidence of hypertension (p = 0.015), and with advanced Suzuki stage (≥ IV) (p < 0.001). During an average follow-up of 37.9 months, patients without APT had a marginally greater incidence of cerebrovascular events (12.9% vs. 9.7%; HR p = 0.069) than those who underwent APT before and after propensity score matching. The subgroup analyses revealed that vessel wall enhancement had a significant interaction effect on the association between APT and stroke outcomes, and APT could significantly reduce stroke risk in MMD patients with vessel wall enhancement (HR =  0.43; 95% CI: 0.23-0.79, interaction p  = 0.038).

CONCLUSION

APT may significantly reduce stroke risk in patients with MMD with vessel wall enhancement.

KEY POINTS

Question The effect of antiplatelet therapy (APT) varies in patients with moyamoya disease (MMD). Findings APT may significantly reduce stroke risk for MMD patients with vessel wall enhancement. Clinical relevance Post-contrast high-resolution MRI may help identify MMD patients who would mostly benefit from APT; APT should be highly recommended in MMD patients with vessel wall enhancement.