Encephaloduroarteriosynangiosis effectively reduces rebleeding risk in adults with hemorrhagic moyamoya disease: A long-term ambidirectional cohort study

This cohort study was conducted using prospective and retrospective data to investigate whether indirect encephaloduroarteriosynangiosis (EDAS) revascularization can reduce the risk of rebleeding in adult patients with hemorrhagic moyamoya disease (hMMD). We enrolled adult patients diagnosed with hMMD prospectively and retrospectively. All patients voluntarily chose to undergo EDAS or conservative treatment. The clinical features, angiographic findings, and follow-up outcomes were investigated and analyzed using the Kaplan–Meier survival analysis and Cox proportional hazards regression models to estimate rebleeding risks post-EDAS. Among the 186 patients with hMMD, 123 patients (66.1%) underwent EDAS, and 63 patients (33.9%) received conservative treatment. In the EDAS group, one (0.8%) patient suffered postoperative infarction, 16 patients (13.0%) experienced recurrent cerebral hemorrhage, and three patients (2.4%) died from rebleeding events. In the conservative treatment group, 18 patients (28.6%, p = 0.015) experienced cerebral rebleeding events and seven (11.1%, p = 0.033) died from rebleeding events. According to the Kaplan–Meier analysis, the annual rebleeding incidence rate was 1.4%/year in the EDAS group and 3.6%/year in the conservative treatment group (p = 0.005, Log-Rank test). Multivariate Cox regression analysis revealed that EDAS surgery was a protective predictor for rebleeding events, while age and the dilation of posterior choroidal artery were positive factors influencing recurrent hemorrhage events. Long-term follow-up results show that, compared to conservative treatment, EDAS revascularization can effectively reduce the rate of recurrent cerebral hemorrhage in adult patients with hMMD.