Efficacy and Safety of IV Thrombolysis for Acute Ischemic Stroke Patients With Moyamoya Disease

Moyamoya disease (MMD) is a rare cerebrovascular condition, and it is a well-known risk factor of acute ischemic stroke (AIS). While IV thrombolysis (IVT) is an established treatment for patients with AIS, its efficacy and safety for patients with MMD is largely unknown. This was a large retrospective analysis of the 2016-2021 Nationwide Readmissions Database in the United States. MMD patients with AIS were included. Patients who underwent bypass surgery were excluded. Propensity score matching (PSM) was performed to match IVT patients with similar patients who were managed conservatively. The primary efficacy outcome was routine discharge to home with self-care. Safety outcomes included intracranial hemorrhage (ICH) and in-hospital mortality. A total of 3,050 MMD patients with AIS were identified, of whom 214 (7.0%) were treated with IVT. After PSM, IVT patients had higher rates of routine discharge compared with those who were not treated with IVT (53.6% vs 45.1%, respectively, p = 0.045). IVT treatment, compared with no-IVT, was not associated with different rates of ICH (7.1% vs 10.9%, p = 0.58) or in-hospital mortality (3.8% vs 5.3%, p = 0.93). IVT is seldom used to treat AIS in patients with MMD, and it may be effective and safe for select cases. Confirmation with prospective studies is needed.