{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:06:12Z","timestamp":1789477572706,"version":"build-2803163510"},"reference-count":29,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Cereb Blood Flow Metab"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>\n                    This cohort study was conducted using prospective and retrospective data to investigate whether indirect encephaloduroarteriosynangiosis (EDAS) revascularization can reduce the risk of rebleeding in adult patients with hemorrhagic moyamoya disease (hMMD). We enrolled adult patients diagnosed with hMMD prospectively and retrospectively. All patients voluntarily chose to undergo EDAS or conservative treatment. The clinical features, angiographic findings, and follow-up outcomes were investigated and analyzed using the Kaplan\u2013Meier survival analysis and Cox proportional hazards regression models to estimate rebleeding risks post-EDAS. Among the 186 patients with hMMD, 123 patients (66.1%) underwent EDAS, and 63 patients (33.9%) received conservative treatment. In the EDAS group, one (0.8%) patient suffered postoperative infarction, 16 patients (13.0%) experienced recurrent cerebral hemorrhage, and three patients (2.4%) died from rebleeding events. In the conservative treatment group, 18 patients (28.6%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.015) experienced cerebral rebleeding events and seven (11.1%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.033) died from rebleeding events. According to the Kaplan\u2013Meier analysis, the annual rebleeding incidence rate was 1.4%\/year in the EDAS group and 3.6%\/year in the conservative treatment group (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.005, Log-Rank test). Multivariate Cox regression analysis revealed that EDAS surgery was a protective predictor for rebleeding events, while age and the dilation of posterior choroidal artery were positive factors influencing recurrent hemorrhage events. Long-term follow-up results show that, compared to conservative treatment, EDAS revascularization can effectively reduce the rate of recurrent cerebral hemorrhage in adult patients with hMMD.\n                  <\/jats:p>","DOI":"10.1177\/0271678x261455499","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T07:03:07Z","timestamp":1780297387000},"page":"2436-2446","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Encephaloduroarteriosynangiosis effectively reduces rebleeding risk in adults with hemorrhagic moyamoya disease: A long-term ambidirectional cohort study"],"prefix":"10.1177","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6389-2347","authenticated-orcid":false,"given":"Qian-Nan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China"},{"name":"Department of Neurosurgery, the Eighth Medical Center of Chinese PLA General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Peng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Mei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Miyun District Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing-Jie","family":"Li","sequence":"additional","affiliation":[{"name":"Medical School of Chinese PLA, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng-Xing","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China"},{"name":"Department of Neurosurgery, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang-Yang","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China"},{"name":"Department of Neurosurgery, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China"},{"name":"Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-Chao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China"},{"name":"Department of Neurosurgery, the Eighth Medical Center of Chinese PLA General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lian","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 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