{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T11:54:09Z","timestamp":1791633249117,"version":"4.3.4"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>The study goal was to evaluate cerebral perfusion in moyamoya patients with a novel staging system and investigate the association between differences of perfusion status and clinical outcomes in patients treated with revascularization.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>About 506 consecutive patients from 2009 to 2015 were enrolled. The perfusion status was evaluated by a staging system-the stage of preinfarction period based on the result of computed tomography perfusion. Hemisphere in different perfusion stage was compared between hemorrhagic patients (n=155) and ischemic patients (n=351). The modified Rankin Scale was applied to evaluate the prognosis of patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>\n              In the enrolled 506 patients: 229 hemispheres (22.6%) with normal perfusion, 72 hemispheres (7.1%) in stage I, 205 hemispheres (20.3%) in stage II, 308 hemispheres (30.4%) in stage III, and 198 hemispheres (19.6%) in stage IV. Significant difference was observed in stage distribution between hemorrhagic patients and ischemic patients (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01). The ratio of hemispheres with normal perfusion in hemorrhagic group is more than the ischemic group (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05; odds ratio, 1.440; 95% CI, 1.144\u20131.811). The ratio of hemispheres in stage III in ischemic group is more than the hemorrhagic group (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01; odds ratio, 0.618, 95% CI, 0.487\u20130.783). In the prognosis-related analysis, the stage I group has the highest improved ratio (73.9%) and the normal perfusion group has the lowest improved ratio (33.3%). The improved ratio has a decreasing tendency from stage I to stage IV.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>The novel preinfarction staging system is a valuable assessment tool to evaluate cerebral perfusion status in moyamoya patients and predict the efficacy of revascularization. Ischemic patients suffer more from hypoperfusion. Patients in stage I and stage II are more likely to obtain improvement after revascularization. This is a retrospective study.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.118.022628","type":"journal-article","created":{"date-parts":[[2018,12,26]],"date-time":"2018-12-26T15:07:11Z","timestamp":1545836831000},"page":"2837-2843","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":50,"title":["A Novel Staging System to Evaluate Cerebral Hypoperfusion in Patients With Moyamoya Disease"],"prefix":"10.1161","volume":"49","author":[{"given":"Hu","family":"Yin","sequence":"first","affiliation":[{"name":"From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingju","family":"Liu","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Zhang","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Wang","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Zhao","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jizong","family":"Zhao","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)"},{"name":"Beijing Key Laboratory of Translational Medicine for Cerebrovascular 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