Endovascular treatment for moyamoya disease in a Caucasian twin with angioplasty and Wingspan stent

The pathogenesis and genetics of moyamoya disease (MMD) remain a mystery. Here we report a case of female Caucasian adult twins with similar presentations of bilateral MMD that were treated with different surgical modalities. One twin was treated with a bypass and remains event free (defined as either transient ischemic event or stroke) at her 4-year follow-up. The second twin underwent angioplasty to treat a left middle cerebral artery stenosis as well as the placement of a Wingspan stent to treat a right supraclinoid ICA stenosis on separate occasions. The left middle cerebral artery angioplasty thrombosed due to the discontinuation of clopidogrel resulting in recurrent symptoms, principally aphasia, and the Wingspan stent underwent angioplasty for in-stent stenosis. Despite this, the stent has been patent and the patient has remained event free at her 2-year follow-up, post-placement. The relatively new Wingspan stent has been used in the past for intracerebral atherosclerotic lesions, however, this is the first report of it being used in a case of MMD. An overview of the MMD literature in twins and endovascular therapy is given.