What is the current consensus regarding antiplatelet therapy for moyamoya disease?
An international survey of perceived experts in the treatment of moyamoya disease reported that the majority of non-Asian respondents recommended antiplatelet therapy, in contrast to their Asian counterparts, perhaps reflecting a difference in the typical pattern of disease seen in the two geographic regions. Several meta-analyses and case series have compared antiplatelet therapy with surgical bypass or observation alone with mixed results. Although some found a benefit or no difference with antiplatelet therapy, others found surgery to be more beneficial. Knowledge gaps exist in understanding moyamoya disease, and no prospective RCTs yet exist comparing medical management with surgical intervention for either the primary or secondary prevention of ischemic events in patients with moyamoya disease.