{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T14:16:48Z","timestamp":1789827408181,"version":"4.0.1"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Predicting the risk of stroke and determining intervention indications are highly important for patients with Moyamoya disease (MMD). Here, we evaluated a novel MMD grading system based on collateral circulation and Suzuki stage to evaluate symptoms and predict prognosis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>In total, 301 idiopathic MMD patients were retrospectively analyzed between 2014 and 2016. A collateral circulation grading system with scores ranging from 1 to 12 was established: the anatomic extent of pial collateral blood flow from posterior cerebral artery to middle cerebral artery and anterior cerebral artery was scored from 1 to 6; perforator collateral and internal cerebral artery flow were scored as 6 to 1, which corresponded to Suzuki stages 1 to 6. Dynamic susceptibility contrast\u2013magnetic resonance imaging was used to evaluate hemodynamic status. We assessed the association between the grading system and clinical characteristics.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>\n              We analyzed 364 symptomatic hemispheres of 301 patients (146 males, 28\u00b116 years). Ischemic patients who presented with infarction were more likely to score &lt;8 points (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), whereas those with ischemia symptoms (transient ischemic attack and headache) were more likely to score &gt;8 points. Hemorrhagic patients who presented with intraparenchymal hemorrhage were more likely to score &lt;8 points, whereas those who presented with intraventricular hemorrhage were more likely to score &gt;8 points (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). According to dynamic susceptibility contrast\u2013magnetic resonance imaging, lower scores were correlated with more severe time to peak delay (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and worse relative cerebral blood volume ratio (\n              <jats:italic>P<\/jats:italic>\n              =0.016) and cerebral flow ratio (\n              <jats:italic>P<\/jats:italic>\n              =0.002). Encephaloduroarteriosynangiosis was performed in 348 symptomatic hemispheres. Patients who had collateral scores &lt;4 points were more likely to have a postoperative stroke and a worse prognosis during the follow-up.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>This new MMD collateral grading system correlated well with clinical symptoms, hemodynamic status, and therapeutic prognosis and may facilitate risk stratification and prognosis predictions in patients with MMD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.119.024487","type":"journal-article","created":{"date-parts":[[2019,8,14]],"date-time":"2019-08-14T09:00:26Z","timestamp":1565773226000},"page":"2708-2715","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":97,"title":["Collateral Circulation in Moyamoya Disease"],"prefix":"10.1161","volume":"50","author":[{"given":"Zhi-wen","family":"Liu","sequence":"first","affiliation":[{"name":"From the Department of Neurosurgery (Z.-w.L., C.H., F.Z., H.W., X.-y.B., Z.-s.Z., W.-z.Y., D.-s.L., L.D.), The 307th Hospital of the Chinese People\u2019s Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong","family":"Han","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery (Z.-w.L., C.H., F.Z., H.W., X.-y.B., Z.-s.Z., W.-z.Y., D.-s.L., L.D.), The 307th Hospital of the Chinese People\u2019s Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhao","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery (Z.-w.L., C.H., F.Z., H.W., X.-y.B., Z.-s.Z., W.-z.Y., D.-s.L., L.D.), The 307th Hospital of the Chinese People\u2019s Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng-gang","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Radiology (P.-g.Q.), The 307th Hospital of the Chinese People\u2019s Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Wang","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery (Z.-w.L., C.H., F.Z., H.W., X.-y.B., Z.-s.Z., W.-z.Y., D.-s.L., L.D.), The 307th Hospital of the Chinese People\u2019s Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang-yang","family":"Bao","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery (Z.-w.L., C.H., F.Z., H.W., X.-y.B., Z.-s.Z., W.-z.Y., D.-s.L., L.D.), The 307th Hospital of the Chinese People\u2019s Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng-shan","family":"Zhang","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery (Z.-w.L., C.H., F.Z., H.W., X.-y.B., Z.-s.Z., W.-z.Y., D.-s.L., L.D.), The 307th Hospital of the Chinese People\u2019s Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-zhong","family":"Yang","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery (Z.-w.L., C.H., F.Z., H.W., X.-y.B., Z.-s.Z., W.-z.Y., D.-s.L., L.D.), The 307th Hospital of the Chinese People\u2019s Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"De-sheng","family":"Li","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery (Z.-w.L., C.H., F.Z., H.W., X.-y.B., Z.-s.Z., W.-z.Y., D.-s.L., L.D.), The 307th Hospital of the Chinese People\u2019s Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lian","family":"Duan","sequence":"additional","affiliation":[{"name":"From the Department of Neurosurgery (Z.-w.L., C.H., F.Z., H.W., X.-y.B., Z.-s.Z., W.-z.Y., D.-s.L., L.D.), The 307th Hospital of the Chinese People\u2019s Liberation Army, The Fifth 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