Objectives: Lacunar infarctions in moyamoya disease have rarely been described. We aimed to evaluate the features and prognosis of adult moyamoya patients with lacunar infarction. Patients and methods: We reviewed 696 consecutive moyamoya patients admitted to our hospital from 2009 to 2015 to identify patients with lacunar infarctions. We compared the clinical features and prognosis of adult moyamoya patients with lacunar infarction and those with non-lacunar infarction. Follow-up was conducted by face-to-face reviews or by a structured telephone interview. Outcome measures were recurrent stroke events and functional outcomes by modified Rankin Scale (mRS). Results: We identified 32 patients with lacunar infarction among 197 adult moyamoya disease patients with infarctions. Patients with lacunar infarctions demonstrated similar angiographic features with patients with non-lacunar infarctions. During a mean follow-up of 33.02 +/- 20.49 months, we observed recurrent stroke events in 1 patients with lacunar infarction and 14 patients with non-lacunar infarction. The mean follow-up mRS was significantly better in the lacunar group than in the non-lacunar group (0.59 +/- 0.56 vs. 1.13 +/- 1.24; P < 0.001). Conclusion: We identified that the moyamoya patients with lacunar infarctions had better functional outcomes comparing with patients with non-lacunar infarction after revascularization.