Endovascular techniques in the management of Moyamoya disease: a comprehensive review of current therapeutic options

Moyamoya disease is a rare cerebrovascular disease that occurs due to narrowing and blockage of the internal carotid arteries and their associated branches resulting in the development of additional collateral vessels. Although the prevalence is higher in Asian countries, there have been documented increases in occurrence globally—the consequences of Moyamoya range from chronic headaches to neurocognitive impairment. Endovascular techniques have emerged as a potential option for managing MMD, particularly for individuals who are unsuitable candidates for direct surgical revascularization or have already undergone such procedures. Various endovascular techniques, such as coiling, stenting, and angioplasty have been used in managing Moyamoya disease. To enhance the safety and efficacy of these interventions, multimodal techniques that combine various endovascular methods are currently being used and studied in clinical trials. This review aims to provide a comprehensive assessment of existing endovascular techniques as well as highlight areas for future development. By reviewing these techniques, a comprehensive analysis of their safety, efficacy, and long-term outcomes was provided in the study. Comparatively, embolization, particularly onyx embolization remains the gold standard for MMD treatment as it provides a more definitive and long-term solution by addressing MMD-associated complications with little to no adverse events. Overall, endovascular techniques showed varying results with some interventions being safer and more effective than others.