2026/11/14 11:40-12:05 Room 401
- Korea-Japan-Taiwan Moyamoya Consensus
- Time
- Topic
- Speaker
- Moderator
- 11:40-12:05
- Clinical Practice Guidelines for Moyamoya Disease in Asia
- SPEAKER:
JinMan Jung
Korea,South (南韓)
- MODERATOR:
Meng-Fai Kuo
郭夢菲
Taiwan (台灣)
- JinMan Jung
- MD, PhD
-
Professor, Department of Neurology, Korea University Ansan Hospital
Director, Stroke Center, Korea University Ansan Hospital
Director, Korea University Geriatric Health Clinic and Research Institute
Lecture Abstract：
Moyamoya disease (MMD) is a progressive cerebrovascular disorder with a high prevalence in East Asia and substantial heterogeneity in clinical presentation and management. We aimed to develop comprehensive, evidence-informed clinical practice guidelines for MMD in Asia. A multidisciplinary writing group primarily from Korea, Japan, and Taiwan developed the guideline using the GRADE methodology, with additional expert participation from India and Malaysia in the modified Delphi consensus process. Twelve key clinical questions were formulated. Systematic literature searches were conducted across major databases through October 2025. When appropriate, meta-analyses were performed. The certainty of evidence and strength of recommendations were graded, and expert consensus was achieved using a modified Delphi process. Evidence was predominantly derived from observational studies. Conditional recommendations are made for antiplatelet therapy in selected adult patients with non-hemorrhagic MMD and for direct or combined revascularization in adults with hemorrhagic MMD. Pediatric technique selection remains individualized. Symptomatic cerebral hyperperfusion syndrome was not quantitatively compared. Advanced imaging modalities, including vessel wall and hemodynamic imaging, may provide adjunctive information but lack definitive evidence for outcome prediction. Routine RNF213 genetic testing for prognostication is not recommended. Evidence for optimal surgical timing, perioperative management, and vascular risk factor control remains limited, supporting individualized approaches. In asymptomatic and pregnant patients, management should be guided by risk stratification and multidisciplinary care. These guidelines provide evidence-informed and consensus-based recommendations for the diagnosis, management, and prognostication of MMD in Asia. Given the limited high-quality evidence, many recommendations remain conditional, highlighting the need for prospective studies and international collaboration to optimize care.
Moyamoya disease (MMD) is a progressive cerebrovascular disorder with a high prevalence in East Asia and substantial heterogeneity in clinical presentation and management. We aimed to develop comprehensive, evidence-informed clinical practice guidelines for MMD in Asia. A multidisciplinary writing group primarily from Korea, Japan, and Taiwan developed the guideline using the GRADE methodology, with additional expert participation from India and Malaysia in the modified Delphi consensus process. Twelve key clinical questions were formulated. Systematic literature searches were conducted across major databases through October 2025. When appropriate, meta-analyses were performed. The certainty of evidence and strength of recommendations were graded, and expert consensus was achieved using a modified Delphi process. Evidence was predominantly derived from observational studies. Conditional recommendations are made for antiplatelet therapy in selected adult patients with non-hemorrhagic MMD and for direct or combined revascularization in adults with hemorrhagic MMD. Pediatric technique selection remains individualized. Symptomatic cerebral hyperperfusion syndrome was not quantitatively compared. Advanced imaging modalities, including vessel wall and hemodynamic imaging, may provide adjunctive information but lack definitive evidence for outcome prediction. Routine RNF213 genetic testing for prognostication is not recommended. Evidence for optimal surgical timing, perioperative management, and vascular risk factor control remains limited, supporting individualized approaches. In asymptomatic and pregnant patients, management should be guided by risk stratification and multidisciplinary care. These guidelines provide evidence-informed and consensus-based recommendations for the diagnosis, management, and prognostication of MMD in Asia. Given the limited high-quality evidence, many recommendations remain conditional, highlighting the need for prospective studies and international collaboration to optimize care.
