Sex differences in clinical presentation and treatment outcomes in moyamoya disease

Nadia Khan, Achal S. Achrol, Raphael Guzman, Terence Burns, Robert Dodd, Teresa Bell-Stephens, Gary K. Steinberg

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

BACKGROUND:: Moyamoya (MM) disease is an idiopathic steno-occlusive angiopathy occurring more frequently in females. OBJECTIVE:: To evaluate sex differences in preoperative symptoms and treatment outcomes after revascularization surgery. METHODS:: We analyzed 430 MM disease patients undergoing 717 revascularization procedures spanning 19 years (1991-2010) and compared gender differences in preoperative symptoms and long-term outcomes after surgical revascularization. RESULTS:: A total of 307 female and 123 male patients (ratio, 2.5:1) with a mean age of 31.0 ± 16.7 years and adults-to-children ratio of 2.5:1 underwent 717 revascularization procedures. Female patients were more likely to experience preoperative transient ischemic attacks (odds ratio: 2.1, P = .001) and less likely to receive a diagnosis of unilateral MM disease (odds ratio: 0.6, P = .04). No association was observed between sex and risk of preoperative ischemic or hemorrhagic stroke. There was no difference in neurological outcome because both male and female patients experienced significant improvement in the modified Rankin Scale score after surgery (P < .0001). On Kaplan-Meier survival analysis, 5-year cumulative risk of adverse postoperative events despite successful revascularization was 11.4% in female vs 5.3% in male patients (P = .05). In multivariate Cox proportional hazards analysis, female sex trended toward an association with adverse postoperative events (hazard ratio: 1.9, P = .14). CONCLUSION:: Female patients are more susceptible to the development of preoperative transient ischemic attack and may be at higher risk of adverse postoperative events despite successful revascularization. There is, however, no sex difference in neurological outcome because patients of both sexes experience significant improvement in neurological status with low risk of the development of future ischemic events after surgical revascularization.

Original languageEnglish (US)
Pages (from-to)587-593
Number of pages7
JournalNeurosurgery
Volume71
Issue number3
DOIs
StatePublished - Sep 1 2012
Externally publishedYes

Fingerprint

Moyamoya Disease
Sex Characteristics
Transient Ischemic Attack
Odds Ratio
Kaplan-Meier Estimate
Survival Analysis
Stroke

Keywords

  • Moyamoya disease
  • Revascularization surgery
  • Sex
  • Treatment outcomes

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Khan, N., Achrol, A. S., Guzman, R., Burns, T., Dodd, R., Bell-Stephens, T., & Steinberg, G. K. (2012). Sex differences in clinical presentation and treatment outcomes in moyamoya disease. Neurosurgery, 71(3), 587-593. https://doi.org/10.1227/NEU.0b013e3182600b3c

Sex differences in clinical presentation and treatment outcomes in moyamoya disease. / Khan, Nadia; Achrol, Achal S.; Guzman, Raphael; Burns, Terence; Dodd, Robert; Bell-Stephens, Teresa; Steinberg, Gary K.

In: Neurosurgery, Vol. 71, No. 3, 01.09.2012, p. 587-593.

Research output: Contribution to journalArticle

Khan, N, Achrol, AS, Guzman, R, Burns, T, Dodd, R, Bell-Stephens, T & Steinberg, GK 2012, 'Sex differences in clinical presentation and treatment outcomes in moyamoya disease', Neurosurgery, vol. 71, no. 3, pp. 587-593. https://doi.org/10.1227/NEU.0b013e3182600b3c
Khan, Nadia ; Achrol, Achal S. ; Guzman, Raphael ; Burns, Terence ; Dodd, Robert ; Bell-Stephens, Teresa ; Steinberg, Gary K. / Sex differences in clinical presentation and treatment outcomes in moyamoya disease. In: Neurosurgery. 2012 ; Vol. 71, No. 3. pp. 587-593.
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AU - Achrol, Achal S.

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AU - Bell-Stephens, Teresa

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N2 - BACKGROUND:: Moyamoya (MM) disease is an idiopathic steno-occlusive angiopathy occurring more frequently in females. OBJECTIVE:: To evaluate sex differences in preoperative symptoms and treatment outcomes after revascularization surgery. METHODS:: We analyzed 430 MM disease patients undergoing 717 revascularization procedures spanning 19 years (1991-2010) and compared gender differences in preoperative symptoms and long-term outcomes after surgical revascularization. RESULTS:: A total of 307 female and 123 male patients (ratio, 2.5:1) with a mean age of 31.0 ± 16.7 years and adults-to-children ratio of 2.5:1 underwent 717 revascularization procedures. Female patients were more likely to experience preoperative transient ischemic attacks (odds ratio: 2.1, P = .001) and less likely to receive a diagnosis of unilateral MM disease (odds ratio: 0.6, P = .04). No association was observed between sex and risk of preoperative ischemic or hemorrhagic stroke. There was no difference in neurological outcome because both male and female patients experienced significant improvement in the modified Rankin Scale score after surgery (P < .0001). On Kaplan-Meier survival analysis, 5-year cumulative risk of adverse postoperative events despite successful revascularization was 11.4% in female vs 5.3% in male patients (P = .05). In multivariate Cox proportional hazards analysis, female sex trended toward an association with adverse postoperative events (hazard ratio: 1.9, P = .14). CONCLUSION:: Female patients are more susceptible to the development of preoperative transient ischemic attack and may be at higher risk of adverse postoperative events despite successful revascularization. There is, however, no sex difference in neurological outcome because patients of both sexes experience significant improvement in neurological status with low risk of the development of future ischemic events after surgical revascularization.

AB - BACKGROUND:: Moyamoya (MM) disease is an idiopathic steno-occlusive angiopathy occurring more frequently in females. OBJECTIVE:: To evaluate sex differences in preoperative symptoms and treatment outcomes after revascularization surgery. METHODS:: We analyzed 430 MM disease patients undergoing 717 revascularization procedures spanning 19 years (1991-2010) and compared gender differences in preoperative symptoms and long-term outcomes after surgical revascularization. RESULTS:: A total of 307 female and 123 male patients (ratio, 2.5:1) with a mean age of 31.0 ± 16.7 years and adults-to-children ratio of 2.5:1 underwent 717 revascularization procedures. Female patients were more likely to experience preoperative transient ischemic attacks (odds ratio: 2.1, P = .001) and less likely to receive a diagnosis of unilateral MM disease (odds ratio: 0.6, P = .04). No association was observed between sex and risk of preoperative ischemic or hemorrhagic stroke. There was no difference in neurological outcome because both male and female patients experienced significant improvement in the modified Rankin Scale score after surgery (P < .0001). On Kaplan-Meier survival analysis, 5-year cumulative risk of adverse postoperative events despite successful revascularization was 11.4% in female vs 5.3% in male patients (P = .05). In multivariate Cox proportional hazards analysis, female sex trended toward an association with adverse postoperative events (hazard ratio: 1.9, P = .14). CONCLUSION:: Female patients are more susceptible to the development of preoperative transient ischemic attack and may be at higher risk of adverse postoperative events despite successful revascularization. There is, however, no sex difference in neurological outcome because patients of both sexes experience significant improvement in neurological status with low risk of the development of future ischemic events after surgical revascularization.

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KW - Treatment outcomes

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