{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T05:19:38Z","timestamp":1792819178583,"version":"4.5.0"},"reference-count":30,"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":[[2024,5]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Moyamoya disease (MMD) is a progressive, occlusive disease of the internal carotid arteries and their proximal branches, with the subsequent development of an abnormal vascular network that is rupture-prone. Steno-occlusive changes in the posterior cerebral arteries (PCAs) may contribute to worsened outcomes in patients with MMD; however, there is little information on the incidence and natural history of posterior circulation MMD (PCMMD). We describe clinical PCMMD characteristics in a large cohort of patients with MMD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>We retrospectively reviewed patients with MMD treated between 1991 and 2019 at a large academic medical center. Demographics, perioperative outcomes, and radiological phenotypes were recorded for 770 patients. PCA disease was graded as either 0 (no disease), 1 (mild), 2 (moderate), or 3 (severe or occluded) based on cerebral angiography. Patients with angiographically confirmed MMD diagnosis with at least 6 months follow-up and completion of revascularization surgery were included; patients with intracranial atherosclerosis, intracranial dissection, vasculitis, and undefined inflammatory processes were excluded. The presence of stenosis\/occlusion was graded radiographically to assess for disease progression and the prevalence of risk factors related to reduced progression-free survival.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              In all, 686 patients met the inclusion criteria, with PCA disease identified in 282 (41.1%) patients. Of those 282 patients with PCMMD, disease severity ranged from 99 (35.1%) with mild, 72 (25.5%) with moderate, and 111 (39.4%) with severe. The total number of postoperative complications was significantly associated with PCMMD severity (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.0067). Additionally, PCMMD severity correlated with worse postoperative modified Rankin Scale scores (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.0001). At a mean follow-up of 6.0\u00b13.9 (range, 0.1\u201325.0) years, a total of 60 (12.6%) patients showed new\/worsening PCMMD. The overall postoperative, progression-free survival in patients with PCMMD was 95.4% at 1 year, 82.4% at 3 years, 68.8% at 5 years, and 28.3% at 10 years, with prognostic factors for progression including preoperative PCMMD status, history of tobacco use, and hypertension (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.0001,\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001, and\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.0001, respectively).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>PCA disease involvement in MMD is associated with higher rates of ischemic perioperative complications and worsened functional outcomes, likely due to reduced collateral flow. Ten-year progression of PCA disease is highly likely and should be monitored throughout follow-up; future studies will assess the impact of PCA disease progression on long-term outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.123.044693","type":"journal-article","created":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T09:00:39Z","timestamp":1712134839000},"page":"1254-1260","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Incidence and Outcomes of Posterior Circulation Involvement in Moyamoya Disease"],"prefix":"10.1161","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2207-9034","authenticated-orcid":true,"given":"Seth S.","family":"Tigchelaar","sequence":"first","affiliation":[{"name":"Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6622-1610","authenticated-orcid":true,"given":"Allan R.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0149-6135","authenticated-orcid":true,"given":"Silvia D.","family":"Vaca","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2333-7736","authenticated-orcid":true,"given":"Yiping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary K.","family":"Steinberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0804622"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00165-X"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.197.1.7568830"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1984.61.6.1032"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3171\/2013.6.JNS122099"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-014-7484-7"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.3171\/2018.1.PEDS17367"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.598565"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nec.2017.02.004"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.4103\/sja.SJA_543_18"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1969.00480090076012"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.0000047120.67507.0d"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.3171\/2020.3.JNS192847"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyz025"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-016-2941-y"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.3171\/ped.2005.103.5.0433"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.3171\/2022.8.JNS22336"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000182256.32489.99"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-014-2136-3"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-018-3985-5"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-013-2123-7"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.3171\/2023.2.JNS222649"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2015.57.6.436"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/105937"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinimag.2014.01.007"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13244-014-0381-x"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-020-01459-0"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2022.01.017"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyaa284"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1159\/000228254"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.123.044693","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T12:05:19Z","timestamp":1751285119000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.123.044693"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5]]},"references-count":30,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1161\/STROKEAHA.123.044693"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.123.044693","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5]]},"assertion":[{"value":"2023-08-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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