{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T21:59:37Z","timestamp":1771883977079,"version":"3.50.1"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,11,21]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Patients with moyamoya disease (MMD) have a high risk of stroke or death. We investigated whether extracranial to intracranial bypass surgery can reduce mortality by preventing strokes in patients with MMD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This nationwide retrospective cohort study encompassed patients with MMD registered under the Rare Intractable Diseases program via the Relieved Co\u2010Payment Policy between 2006 and 2019, using the Korean National Health Insurance Service database. Following a 4\u2010year washout period, landmark analyses were employed to assess mortality and stroke occurrence between the bypass surgery group and the nonsurgical control group at specific time points postindex date (1 month and 3, 6, 12, and 36 months). The study included 18\u2009480 patients with MMD (mean age, 40.7\u2009years; male to female ratio, 1:1.86) with a median follow\u2010up of 5.6\u2009years (interquartile range, 2.5\u20139.3;\u00a0mean, 6.1 years [SD, 4.0\u2009years]). During 111\u2009775 person\u2010years of follow\u2010up, 265 patients in the bypass surgery group and 1144 patients in the nonsurgical control group died (incidence mortality rate of 618.1 events versus 1660.3 events, respectively, per 10\n              <jats:sup>5<\/jats:sup>\n              person\u2010years). The overall adjusted hazard ratio (HR) revealed significantly lower all\u2010cause mortality in the bypass surgery group from the 36\u2010month landmark time point, for any stroke mortality from 3\u2010 and 6\u2010month landmark time points, and for hemorrhagic stroke mortality from the 6\u2010month landmark time point. Furthermore, the overall adjusted HRs for hemorrhagic stroke occurrence were beneficially maintained from all 5 landmark time points in the bypass surgery group.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Bypass surgery in patients with MMD was associated with a lower risk of all\u2010cause and hemorrhagic stroke mortality and hemorrhagic stroke occurrence compared with nonsurgical control.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.030834","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T10:17:50Z","timestamp":1699611470000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Association of Bypass Surgery and Mortality in Moyamoya Disease"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0424-3806","authenticated-orcid":false,"given":"Hyunjun","family":"Park","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Incheon St. Mary\u2019s Hospital, College of Medicine The Catholic University of Korea Incheon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5011-5557","authenticated-orcid":false,"given":"Minkyung","family":"Han","sequence":"additional","affiliation":[{"name":"Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics Yonsei University College of Medicine Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6736-1818","authenticated-orcid":false,"given":"Dong\u2010Kyu","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Incheon St. Mary\u2019s Hospital, College of Medicine The Catholic University of Korea Incheon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2663-9163","authenticated-orcid":false,"given":"Dal\u2010Soo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Myong\u2010Ji St. Mary\u2019s Hospital Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5479-3736","authenticated-orcid":false,"given":"Pil\u2010Woo","family":"Huh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Uijeongbu St. Mary\u2019s Hospital. College of Medicine The Catholic University of Korea Gyeonggi\u2010do Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7132-7009","authenticated-orcid":false,"given":"Hae\u2010Kwan","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Eunpyeong St. Mary\u2019s Hospital, College of Medicine The Catholic University of Korea Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8187-7204","authenticated-orcid":false,"given":"Ik Seong","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Bucheon St. Mary\u2019s Hospital, College of Medicine The Catholic University of Korea Gyeonggi\u2010do Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7390-7816","authenticated-orcid":false,"given":"Young\u2010Min","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Naeun Hospital Incheon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3738-6413","authenticated-orcid":false,"given":"Jae Hoon","family":"Sung","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Vincent\u2019s Hospital, College of Medicine The Catholic University of Korea Gyeonggi\u2010do Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3700-2485","authenticated-orcid":false,"given":"Kwan\u2010Sung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul St. Mary\u2019s Hospital, College of Medicine The Catholic University of Korea Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5769-3974","authenticated-orcid":false,"given":"Hyung\u2010Jin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Daejeon St. Mary\u2019s Hospital, College of Medicine The Catholic University of Korea Daejeon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9825-4927","authenticated-orcid":false,"given":"Young Woo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Uijeongbu St. Mary\u2019s Hospital. 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