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

The "Efficacy and Safety of IV Thrombolysis for Acute Ischemic Stroke Patients With Moyamoya Disease" study was a retrospective analysis of administrative data to examine the safety and efficacy of intravenous thrombolysis (IVT) in patients with moyamoya disease (MMD). Here, we examine this study in detail, looking at its strengths and limitations. The authors identified 3,050 patients with MMD of whom 214 (7.0%) had received IVT. The study used propensity score matching (PSM), a technique which aims to reduce confounding by matching treatment and control groups. After PSM, there were 212 patients in the IVT group and 818 patients in the no-IVT group. A higher proportion of patients in the IVT group had a good outcome (return to home with self-care) than the no-IVT group (53.6% [95% CI 42.7%-63.3%] vs 45.1% [95% CI 39.9%-50.3%]). There were no differences in intracranial hemorrhage (ICH) or mortality between groups. The main strength of this study was the large sample size acquired from nationwide data for this uncommon disease. A few limitations include (1) the observational nature of the study with lack of details about the definition of MMD or of ICH, (2) lack of confirmatory imaging evidence of infarct at 24 hours, and (3) limitations inherent to the technique of PSM. In summary, this study was the first large retrospective study to provide evidence that IVT may be safe in patients with MMD. Future studies are needed to determine whether there is benefit of IVT in these patients.