{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:13:34Z","timestamp":1792026814843,"version":"4.4.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2014,5]]},"abstract":"\n Background and Purpose\u2014<\/jats:title>\n About one half of those who develop adult-onset moyamoya disease experience intracranial hemorrhage. Despite the extremely high frequency of rebleeding attacks and poor prognosis, measures to prevent rebleeding have not been established. The purpose of this study is to determine whether extracranial\u2013intracranial bypass can reduce incidence of rebleeding and improve patient prognosis.<\/jats:p>\n <\/jats:sec>\n \n Methods\u2014<\/jats:title>\n This study was a multicentered, prospective, randomized, controlled trial conducted by 22 institutes in Japan. Adult patients with moyamoya disease who had experienced intracranial hemorrhage within the preceding year were given either conservative care or bilateral extracranial\u2013intracranial direct bypass and were observed for 5 years. Primary and secondary end points were defined as all adverse events and rebleeding attacks, respectively.<\/jats:p>\n <\/jats:sec>\n \n Results\u2014<\/jats:title>\n \n Eighty patients were enrolled (surgical, 42; nonsurgical, 38). Adverse events causing significant morbidity were observed in 6 patients in the surgical group (14.3%) and 13 patients in the nonsurgical group (34.2%). Kaplan\u2013Meier survival analysis revealed significant differences between the 2 groups (3.2%\/y versus 8.2%\/y;\n P<\/jats:italic>\n =0.048). The hazard ratio of the surgical group calculated by Cox regression analysis was 0.391 (95% confidence interval, 0.148\u20131.029). Rebleeding attacks were observed in 5 patients in the surgical group (11.9%) and 12 in the nonsurgical group (31.6%), significantly different in the Kaplan\u2013Meier survival analysis (2.7%\/y versus 7.6%\/y;\n P<\/jats:italic>\n =0.042). The hazard ratio of the surgical group was 0.355 (95% confidence interval, 0.125\u20131.009).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions\u2014<\/jats:title>\n Although statistically marginal, Kaplan\u2013Meier analysis revealed the significant difference between surgical and nonsurgical group, suggesting the preventive effect of direct bypass against rebleeding.<\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration\u2014<\/jats:title>\n \n URL:\n http:\/\/www.umin.ac.jp\/ctr\/index.htm<\/jats:ext-link>\n . Unique identifier: C000000166.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/strokeaha.113.004386","type":"journal-article","created":{"date-parts":[[2014,3,25]],"date-time":"2014-03-25T23:40:35Z","timestamp":1395790835000},"page":"1415-1421","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":563,"title":["Effects of Extracranial\u2013Intracranial Bypass for Patients With Hemorrhagic Moyamoya Disease"],"prefix":"10.1161","volume":"45","author":[{"given":"Susumu","family":"Miyamoto","sequence":"first","affiliation":[{"name":"From the Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.M., J.C.T.); Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan (T.Y.); National Cerebral and Cardiovascular Center, Suita, Japan (N.H.); Department of Cerebrovascular Disease and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (Y.O.); Departments of Public Health (I.T.) and Neurosurgery (T.T.), Tohoku University Graduate School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Yoshimoto","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.M., J.C.T.); Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan (T.Y.); National Cerebral and Cardiovascular Center, Suita, Japan (N.H.); Department of Cerebrovascular Disease and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (Y.O.); Departments of Public Health (I.T.) and Neurosurgery (T.T.), Tohoku University Graduate School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuo","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.M., J.C.T.); Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan (T.Y.); National Cerebral and Cardiovascular Center, Suita, Japan (N.H.); Department of Cerebrovascular Disease and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (Y.O.); Departments of Public Health (I.T.) and Neurosurgery (T.T.), Tohoku University Graduate School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Okada","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.M., J.C.T.); Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan (T.Y.); National Cerebral and Cardiovascular Center, Suita, Japan (N.H.); Department of Cerebrovascular Disease and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (Y.O.); Departments of Public Health (I.T.) and Neurosurgery (T.T.), Tohoku University Graduate School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Tsuji","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.M., J.C.T.); Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan (T.Y.); National Cerebral and Cardiovascular Center, Suita, Japan (N.H.); Department of Cerebrovascular Disease and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (Y.O.); Departments of Public Health (I.T.) and Neurosurgery (T.T.), Tohoku University Graduate School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teiji","family":"Tominaga","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.M., J.C.T.); Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan (T.Y.); National Cerebral and Cardiovascular Center, Suita, Japan (N.H.); Department of Cerebrovascular Disease and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (Y.O.); Departments of Public Health (I.T.) and Neurosurgery (T.T.), Tohoku University Graduate School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyoji","family":"Nakagawara","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.M., J.C.T.); Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan (T.Y.); National Cerebral and Cardiovascular Center, Suita, Japan (N.H.); Department of Cerebrovascular Disease and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (Y.O.); Departments of Public Health (I.T.) and Neurosurgery (T.T.), Tohoku University Graduate School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun C.","family":"Takahashi","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.M., J.C.T.); Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan (T.Y.); National Cerebral and Cardiovascular Center, Suita, Japan (N.H.); Department of Cerebrovascular Disease and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (Y.O.); Departments of Public Health (I.T.) and Neurosurgery (T.T.), Tohoku University Graduate School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasutake","family":"Tomata","sequence":"additional","affiliation":[{"name":"Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuguya","family":"Fukui","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, St. Luke\u2019s International Hospital, Tokyo, 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for Hemorrhagic Moyamoya Disease. Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of Ministry of Health Labor and Welfare: Annual Report 2000 (in Japanese)","author":"Karasawa J","year":"2001","unstructured":"Karasawa J, Hosoi K, Morisako TRevascularization for Hemorrhagic Moyamoya Disease. Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of Ministry of Health Labor and Welfare: Annual Report 2000 (in Japanese). Tokyo, Japan: Ministry of Health, Labor, and Welfare; 2001:55\u201358."},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0303-8467(97)00078-4"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.113.004386","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:43:15Z","timestamp":1715596995000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.113.004386"}},"subtitle":["Results of the Japan Adult Moyamoya Trial"],"short-title":[],"issued":{"date-parts":[[2014,5]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2014,5]]}},"alternative-id":["10.1161\/STROKEAHA.113.004386"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.113.004386","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,5]]},"assertion":[{"value":"2013-12-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-01-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-03-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}