{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:28:50Z","timestamp":1791919730655,"version":"4.3.4"},"reference-count":33,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T00:00:00Z","timestamp":1756512000000},"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":["European Stroke Journal"],"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Asymptomatic moyamoya angiopathy (MMA) is increasingly detected through noninvasive imaging; however, its optimal management remains controversial. This multicenter retrospective cohort study compared outcomes in asymptomatic versus symptomatic MMA patients undergoing surgical revascularization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods:<\/jats:title>\n                    <jats:p>A total of 475 patients treated with bypass surgery across multiple academic centers were included, with 56 (11.8%) classified as asymptomatic and 419 (88.2%) as symptomatic. Baseline demographics, surgical characteristics, and outcomes-including perioperative stroke, intraoperative complications, and follow-up stroke events-were collected. Asymptomatic MMA was defined as the absence of any prior ischemic or hemorrhagic stroke, seizures, or other neurological symptoms at the time of diagnosis. Both unadjusted analyses and propensity score weighting using inverse probability of treatment weighting (IPTW) were performed to adjust for potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In the unadjusted analysis, asymptomatic patients had significantly lower rates of all perioperative strokes (1.7% vs 11.4%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05) and intraoperative complications (1.7% vs 11.2%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05) compared to symptomatic patients. Additionally, follow-up stroke rates were lower in the asymptomatic group (1.7% vs 11.2%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05). After IPTW adjustment, the reduction in intraoperative complications (OR: 0.08, 95% CI: 0.01\u20130.64;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) and follow-up stroke rates (OR: 0.12, 95% CI: 0.01\u20130.91;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04) persisted, while differences in overall perioperative stroke were not statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Bypass surgery in selected asymptomatic MMA patients is associated with reduced intraoperative complications, and fewer follow-up stroke rates. These findings support the careful consideration of surgical intervention in asymptomatic patients, emphasizing the importance of patient selection for optimal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23969873251365504","type":"journal-article","created":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T09:36:18Z","timestamp":1756546578000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of bypass surgery in asymptomatic moyamoya angiopathy: A multicenter study with propensity-score weighting"],"prefix":"10.1093","author":[{"given":"Basel","family":"Musmar","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hammam","family":"Abdalrazeq","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna M","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimer","family":"Adeeb","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Atallah","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kareem","family":"El Naamani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7830-9273","authenticated-orcid":false,"given":"Ching-Jen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Texas Health Science Center, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Jabre","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Saad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A","family":"Grossberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam A","family":"Dmytriw","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, University of Toronto Faculty of Medicine, Toronto, ON, Canada"},{"name":"Neuroendovascular Program, Massachusetts General Hospital &amp; Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman B","family":"Patel","sequence":"additional","affiliation":[{"name":"Neuroendovascular Program, Massachusetts General Hospital &amp; Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirhojjat","family":"Khorasanizadeh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S","family":"Ogilvy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajith J","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New York at Buffalo, Buffalo, NY, Buffalo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New York at Buffalo, Buffalo, NY, Buffalo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo M","family":"Cortez","sequence":"additional","affiliation":[{"name":"Lyerly Neurosurgery, Baptist Health System, Jacksonville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo A","family":"Hanel","sequence":"additional","affiliation":[{"name":"Lyerly Neurosurgery, Baptist Health System, Jacksonville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme","family":"Porto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro M","family":"Spiotta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony J","family":"Piscopo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Ghorbani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Firoozgar Hospital, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Weinberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahid M","family":"Nimjee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimon","family":"Bekelis","sequence":"additional","affiliation":[{"name":"Good Samaritan Hospital Medical Center, Babylon, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed M","family":"Salem","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Karl","family":"Burkhardt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akli","family":"Zetchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University, New Haven, CT, USA"},{"name":"Department of Neurosurgery and of Radiology and 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