This is an invited editorial commentary on: PBC-22-1057 - Cerebral Revascularization Surgery Reduces Cerebrovascular Events in Children with Sickle Cell Disease and Moyamoya Syndrome Results of the Stroke in Sickle Cell Revascularization Surgery (SiSCRS) Retrospective Study

Disclosures Statement - No relevant financial conflicts of interest.

Acknowledgement – Medical writing assistance from Kenneth Rasinski is gratefully acknowledged. No funding was received for this work.

ABSTRACT

Stroke in Sickle Cell Revascularization Surgery Retrospective Study (SiSCRS) in this issue reports retrospective data from 15 medical centers to examine the benefit of cerebral revascularization surgery (CRS) in children with sickle cell disease (SCD) who also have Moyamoya Syndrome (SCD-MMS). The American Society of Hematology guidelines “suggests evaluation for revascularization surgery in addition to regular blood transfusion” for treating SCD-MMS combined with a history of stroke or transient ischemic attack but categorizes this as a “conditional recommendation based on very low certainty in the evidence about effects”. The research presented in this article is aimed at reducing the uncertainty surrounding revascularization surgery as a treatment using retrospective data from 15 medical centers with expertise in CRS for SCD-MMS. Even with the 78 children with CRS (Surgery group) and 63 children in the non-surgery (Conservative group), the differences between the two groups had mixed statistical significance in multivariate analyses. SiSCRS is an important retrospective analysis but must be interpreted with caution. The benefit of CRS attains statistical significance only in some of the comparisons. The rate of stroke in pediatric SCD decreases with age, creating a bias in favor of the older group (i.e., the Surgery Group) to have fewer CVEs, The additional role of aspirin and the bias of patient selection for surgery also weaken the ability to make definitive statements. The SiSCRS results suggest a likely retrospective benefit of CRS, but the benefit must be demonstrated with more rigorous studies in the future.