Safety and Efficacy of RIC in Pediatric Moyamoya Disease Patients Treated With Revascularization Therapy

Inclusion Criteria:

• Age: ≥0 and ≤18

• All of the patients underwent digital subtraction angiography and met the currentdiagnostic criteria recommended by the Research Committee on MMD (SpontaneousOcclusion of the Circle of Willis) of the Ministry of Health and Welfare of Japan in 2012

• Suzuki stages concentrated in Stage III and IV

• Presentation with ischemic symptoms, such as transient ischemic attack (TIA),headache, seizure, hemorrhagic stroke, and ischemic stroke confirmed by MRI

• Informed consent obtained from patient or acceptable patient's surrogate

Exclusion Criteria:

• Severe hepatic or renal dysfunction

• Severe hemostatic disorder or severe coagulation dysfunction

• Patients with unilateral MMD or the presence of secondary moyamoya phenomenon causedby autoimmune disease, Down syndrome, neurofibromatosis, leptospiral infection, orprevious skull-base radiation therapy

• Any of the following cardiac disease - rheumatic mitral and or aortic stenosis,prosthetic heart valves, atrial fibrillation, atrial flutter, sick sinus syndrome,left atrial myxoma, patent foramen ovale, left ventricular mural thrombus orvalvular vegetation, congestive heart failure, bacterial endocarditis, or any othercardiovascular condition interfering with participation

• Serious, advanced, or terminal illnesses with anticipated life expectancy of lessthan one year

• Patient participating in a study involving other drug or device trial study

• Patients with existing neurological or psychiatric disease that would confound theneurological or functional evaluations

• Unlikely to be available for follow-up for 3 months

• Contraindication for RIC - severe soft-tissue injury, fracture, or peripheralvascular disease in the upper limbs.