{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T04:35:53Z","timestamp":1792730153300,"version":"4.5.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2011,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Purpose\u2014<\/jats:title>\n                    <jats:p>The purpose of this study was to evaluate in symptomatic moyamoya patients the effect of surgical revascularization on impaired cerebrovascular reactivity (CVR) and its relationship to clinical outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods\u2014<\/jats:title>\n                    <jats:p>Brain revascularization was performed using a direct superficial temporal artery to middle cerebral artery bypass or indirect encephalo-dural\u2013arterial synangiosis. CVR was measured pre- and 3 months postoperatively using blood oxygen level-dependent MRI during iso-oxic hypercapnic changes in end-tidal carbon dioxide. Outcomes were assessed by MRI, clinical examination, and modified Rankin Scale scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results\u2014<\/jats:title>\n                    <jats:p>\n                      Fifty-five hemispheres were revascularized in 39 patients (superficial temporal artery to middle cerebral artery in 47, encephalo-dural\u2013arterial synangiosis in 8). Surgery reversed CVR impairment in 52 hemispheres (94.5%) and in 36 of 39 patients (92.3%; Fisher exact test,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), and this was predictive of a patent extracranial\u2013intracranial bypass. New, clinically silent perioperative hemorrhages, cortical foci of ischemia, or new white matter T2 hyperintensities were detected after 11 surgeries (20%), but no new lesions arose after 3 postoperative months. One patient had a clinical perioperative stroke (1.8%). In clinical follow-up, 37 of 39 patients (95%) had stable or improved modified Rankin Scale scores and 2 patients (5.1%) worsened. No patients with patent bypasses or CVR improvements exhibited new clinical symptoms, but failure of CVR improvement corresponded to a poorer long-term outcome (Fisher exact test,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>Cerebral revascularization surgery is a safe and effective treatment for reversing preoperative CVR defects and may prevent recurrence of preoperative symptoms. Moreover, CVR measurements may be useful in long-term follow-up and for predicting bypass patency.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.111.615955","type":"journal-article","created":{"date-parts":[[2011,9,9]],"date-time":"2011-09-09T11:30:54Z","timestamp":1315567854000},"page":"3047-3054","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":85,"title":["Impact of Extracranial\u2013Intracranial Bypass on Cerebrovascular Reactivity and Clinical Outcome in Patients With Symptomatic Moyamoya Vasculopathy"],"prefix":"10.1161","volume":"42","author":[{"given":"Jay S.","family":"Han","sequence":"first","affiliation":[{"name":"From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal","family":"Abou-Hamden","sequence":"additional","affiliation":[{"name":"From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Mandell","sequence":"additional","affiliation":[{"name":"From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Poublanc","sequence":"additional","affiliation":[{"name":"From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian P.","family":"Crawley","sequence":"additional","affiliation":[{"name":"From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A.","family":"Fisher","sequence":"additional","affiliation":[{"name":"From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Mikulis","sequence":"additional","affiliation":[{"name":"From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Tymianski","sequence":"additional","affiliation":[{"name":"From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0303-8467(97)00082-6"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2005-868161"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-004-1118-9"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0804622"},{"key":"e_1_3_4_6_2","first-page":"1191","article-title":"Results of an international randomized trial. 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