Introduction/Aims: There is limited evidence regarding recurrent cerebrovascular events in patients with Moyamoya Angiopathy (MMA) who initially present with either ischaemic or haemorrhagic events. This study aimed to determine the incidence and nature of the first recurrent event in MMA patients, specifically focusing on the influence of initial presentation.
Methods: We conducted a retrospective cohort study of symptomatic MMA patients in Auckland, New Zealand. Data were collected on demographics, antithrombotic use, revascularisation surgery, and first recurrent ischaemic or haemorrhagic events. We used descriptive statistics, Fisher’s exact test for grouped comparisons, and logistic regression to test associations.
Results: Eighty-one patients (73% female), mean age 37.6 years (SD±17) were included, with 437 patient-years (median 2.4 years, IQR 0.4-7.3) of follow-up. At presentation, 20% had haemorrhagic stroke, and the remainder had ischaemic events. Antithrombotic use was higher in ischaemic (82%) than haemorrhagic (25%) cases. Revascularisation was performed in 27% of ischaemic and 13% of haemorrhagic patients respectively. At follow-up, 60% had no further events. Among haemorrhagic-onset patients, 6% had subsequent ischaemia and 31% had recurrent haemorrhage. Among ischaemic-onset patients, 34% had recurrent ischaemia, and 9% had haemorrhagic stroke (p<0.05). Follow-up haemorrhagic stroke was negatively associated with independence (mRS 0-2), [OR 0.17, 95%CI 0.04-0.71;p<0.05].
Conclusion: These findings suggest that initial stroke type may influence the recurrence pattern in MMA, with distinct phenotypes emerging based on the initial presentation. This distinction could inform decisions regarding clinical management; however, these results should be validated prospectively in larger cohorts to confirm their applicability to broader patient populations.