{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:06:08Z","timestamp":1787501168237,"version":"build-2736575974"},"reference-count":24,"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":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Identifying the optimal surgical timing is critical for reducing stroke risk in pediatric patients with moyamoya disease, but evidence to guide clinical decision-making remains limited. This study aimed to determine the optimal surgical timing based on different symptom onset patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We retrospectively reviewed pediatric patients with moyamoya disease who underwent revascularization surgery at a single center in China between July 2007 and July 2018. Patients were categorized by symptom onset pattern: infarction-onset, transient ischemic attack (TIA)-onset, or nonischemic. The TIA-onset group was further subdivided into high-risk and low-risk subgroups. Data on preoperative\/perioperative stroke events and diagnosis-to-operation intervals were collected. Receiver operating characteristic curves and multivariate analyses were used to identify surgical timing thresholds. Stroke incidences were compared across groups stratified by surgical interval.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      A total of 736 patients (mean age 7.2\u00b13.9 years; 50.7% male) were included. The incidence density of preoperative cerebral infarction was 11.83 per 1000 person-months, while that of cerebral hemorrhage was 1.21 per 1000 person-months. For patients with infarction-onset and high-risk TIA-onset patterns, a surgical waiting time exceeding 2.5 months (area under the curve, 0.722; specificity, 0.561; sensitivity, 0.882;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) and 6.5 months (area under the curve, 0.631; specificity, 0.400; sensitivity, 0.804;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.006), respectively, was associated with a significantly increased risk of preoperative cerebral infarction. In nonischemic patients, a prolonged surgical waiting time exceeding 5 years (area under the curve, 0.761; specificity, 0.856; sensitivity, 0.571;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.05) was associated with a significantly increased risk of cerebral hemorrhage. For patients with initial symptoms of infarction or high-risk TIA, earlier surgery did not increase the incidence of perioperative stroke events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>For children with moyamoya disease, surgical intervention was beneficial within 2.5 months for patients with infarction-onset, 6.5 months for patients with high-risk TIA onset, and 5 years for nonischemic patients in reducing stroke risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.052044","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T09:00:36Z","timestamp":1758099636000},"page":"3352-3360","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Optimizing Surgical Timing to Reduce Stroke Risk in Pediatric Moyamoya Disease"],"prefix":"10.1161","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3651-4383","authenticated-orcid":true,"given":"Jiali","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Neurology Center, Beijing Shijitan Hospital, Capital Medical University, China (J.X., X.J., X.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing, China (B.L., H.F., H.D.Z., L.D., C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5778-0234","authenticated-orcid":true,"given":"Heguan","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing, China (B.L., H.F., H.D.Z., L.D., C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangfeng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital (S.H., X.J.), Capital Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HouDi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing, China (B.L., H.F., H.D.Z., L.D., C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0527-2852","authenticated-orcid":true,"given":"Xunming","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Neurology Center, Beijing Shijitan Hospital, Capital Medical University, China (J.X., X.J., X.C.)."},{"name":"Department of Neurology, Xuanwu Hospital (S.H., X.J.), Capital Medical University, China."},{"name":"Beijing Institute of Brain Disorders (X.J.), Capital Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7210-056X","authenticated-orcid":true,"given":"Lian","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing, China (B.L., H.F., H.D.Z., L.D., C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueli","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Neurology Center, Beijing Shijitan Hospital, Capital Medical University, China (J.X., X.J., X.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijie","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Emergency, Xuanwu Hospital (S.L.), Capital Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0418-6143","authenticated-orcid":true,"given":"Cong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing, China (B.L., H.F., H.D.Z., L.D., 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