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Abstract Background As a progressive cerebrovascular disease, Moyamoya Disease (MMD) is a common cause of stroke in children and adults. However, the early biomarkers and pathogenesis of MMD remain poorly understood. Methods and material This study was conducted using plasma exosome samples from MMD patients. Next-generation high-throughput sequencing, real-time quantitative PCR, gene ontology analysis, and Kyoto Encyclopaedia of Genes and Genomes pathway analysis of ideal exosomal miRNAs that could be used as potential biomarkers of MMD were performed. The area under the Receiver Operating Characteristic (ROC) curve was used to evaluate the sensitivity and specificity of biomarkers for predicting events. Results Exosomes were successfully isolated and miRNA-sequence analysis yielded 1,002 differentially expressed miRNAs. Functional analysis revealed that they were mainly enriched in axon guidance, regulation of the actin cytoskeleton and the MAPK signaling pathway. Furthermore, 10 miRNAs (miR-1306-5p, miR-196b-5p, miR-19a-3p, miR-22-3p, miR-320b, miR-34a-5p, miR-485-3p, miR-489-3p, miR-501-3p, and miR-487-3p) were found to be associated with the most sensitive and specific pathways for MMD prediction. Conclusions Several plasma secretory miRNAs closely related to the development of MMD have been identified, which can be used as biomarkers of MMD and contribute to differentiating MMD from non-MMD patients before digital subtraction angiography. disease (MMD adults However understood Nextgeneration Next generation highthroughput high throughput sequencing realtime real time PCR performed ROC (ROC events miRNAsequence miRNA sequence 1002 1 002 1,00 guidance Furthermore miR13065p, miR13065p miRp miR 1306 5p, 5p p (miR-1306-5p miR196b5p, miR196b5p miRbp 196b b miR-196b-5p miR19a3p, miR19a3p miRap 19a 3p, 3p miR-19a-3p miR223p, miR223p 22 miR-22-3p miR320b, miR320b miRb 320b, 320b miR-320b miR34a5p, miR34a5p 34a miR-34a-5p miR4853p, miR4853p 485 miR-485-3p miR4893p, miR4893p 489 miR-489-3p miR5013p, miR5013p 501 miR-501-3p miR4873p 487 miR-487-3p prediction identified nonMMD non angiography 100 00 1,0 130 2 48 50 0 1, 13 4 5