{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T10:55:59Z","timestamp":1784112959126,"version":"3.55.0"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2009,4]]},"abstract":"<jats:p>Moyamoya disease is an obliterative vasculopathy of the large arteries at the base of the brain. In the US, it most commonly affects women in their 3rd and 4th decades of life, frequently causing ischemic stroke. The natural history of this disorder is not well described. It is very likely that hemodynamic factors play an important role in the risk of future stroke, as has been established in atherosclerotic carotid occlusive disease.<\/jats:p>\n                  <jats:p>The authors describe an ongoing, prospective observational study designed to test the hypothesis that increased oxygen extraction in the cerebral hemisphere beyond the occlusive lesion is a predictor of subsequent risk of ipsilateral stroke in medically treated patients with moyamoya phenomenon. On enrollment, all patients undergo regional measurements of cerebral oxygen extraction fraction (OEF) with PET. Information on baseline clinical, laboratory, epidemiological, and angiographic risk factors are obtained at the time of the PET study. Decisions regarding surgery are made by the treating physicians based on clinical information while being blinded to PET data. Patients undergo follow-up at 6-month intervals to determine the subsequent risk of ipsilateral stroke. All patients will return at 1 and 3 years for repeat PET studies. Secondary, exploratory, aims of this longitudinal and blinded study are to determine other predictive factors for stroke in this population; to determine preliminary estimates of the effects of different medical treatment regimens in this population; to determine the temporal changes in hemodynamic impairment in medically treated patients; to determine the effects of surgery on hemodynamic impairment in the subset of patients who undergo surgical revascularization; and to obtain estimates of surgical complication rates for patients with and without hemodynamic impairment.<\/jats:p>","DOI":"10.3171\/2009.01.focus08305","type":"journal-article","created":{"date-parts":[[2009,3,31]],"date-time":"2009-03-31T12:12:42Z","timestamp":1238501562000},"page":"E6","source":"Crossref","is-referenced-by-count":26,"title":["Cerebral hemodynamics as a predictor of stroke in adult patients with moyamoya disease: a prospective observational study"],"prefix":"10.3171","volume":"26","author":[{"given":"Gregory J.","family":"Zipfel","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery,"},{"name":"Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Sagar","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Phillip","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Biostatistics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom O.","family":"Videen","sequence":"additional","affiliation":[{"name":"Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Grubb","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph G.","family":"Dacey","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin P.","family":"Derdeyn","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery,"},{"name":"Department of Neurology, and"},{"name":"Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0260006","series-title":"Stroke","first-page":"826","article-title":"Cerebral infarction due to moyamoya disease in young adults","volume":"19","author":"Bruno","year":"1988"},{"key":"b2-0260006","series-title":"N Engl J Med","first-page":"1305","article-title":"Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis","volume":"352","author":"Chimowitz","year":"2005"},{"key":"b3-0260006","series-title":"Stroke","first-page":"1347","article-title":"Clinical features of Moyamoya disease in the United States","volume":"29","author":"Chiu","year":"1998"},{"key":"b4-0260006","series-title":"Neuroradiology","first-page":"772","article-title":"Idiopathic supraclinoid and internal carotid bifurcation steno-occlusive disease in young American adults","volume":"41","author":"Cloft","year":"1999"},{"key":"b5-0260006","series-title":"Neurology","first-page":"251","article-title":"Cerebral hemodynamic impairment: methods of measurement and association with stroke risk","volume":"53","author":"Derdeyn","year":"1999"},{"key":"b6-0260006","series-title":"Stroke","first-page":"1019","article-title":"Compensatory mechanisms for chronic cerebral hypoperfusion in patients with carotid occlusion","volume":"30","author":"Derdeyn","year":"1999"},{"key":"b7-0260006","series-title":"J Nucl Med","first-page":"1195","article-title":"Comparison of PET oxygen extraction fraction methods for the prediction of stroke risk","volume":"42","author":"Derdeyn","year":"2001"},{"key":"b8-0260006","series-title":"N Engl J Med","first-page":"1191","article-title":"Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke: results of an international randomized trial","volume":"313","author":"EC\/IC Bypass Study Group","year":"1985"},{"key":"b9-0260006","series-title":"JAMA","first-page":"1055","article-title":"Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion","volume":"280","author":"Grubb","year":"1998"},{"key":"b10-0260006","series-title":"Stroke","first-page":"1490","article-title":"Clinical features and outcome in North American adults with moyamoya phenomenon","volume":"37","author":"Hallemeier","year":"2006"},{"key":"b11-0260006","series-title":"Neuroradiology","first-page":"15","article-title":"Sequential change of hemodynamic reserve in patients with major cerebral artery occlusions or severe stenosis","volume":"34","author":"Hasegawa","year":"1992"},{"key":"b12-0260006","series-title":"Surg Neurol","first-page":"251","article-title":"Evaluation of cerebral blood flow and hemodynamic reserve in symptomatic moyamoya disease using stable Xenon-CT blood flow","volume":"44","author":"Horowitz","year":"1995"},{"key":"b13-0260006","series-title":"J Neurosurg","first-page":"843","article-title":"Cerebral circulation and oxygen metabolism in childhood moyamoya disease: a perioperative positron emission tomography study","volume":"81","author":"Ikezaki","year":"1994"},{"key":"b14-0260006","series-title":"Cerebrovasc Dis","first-page":"109","article-title":"Progression of unilateral moyamoya disease: a clinical series","volume":"22","author":"Kelly","year":"2006"},{"key":"b15-0260006","series-title":"Stroke","first-page":"2084","article-title":"Symptomatic carotid artery occlusion: a reappraisal of hemodynamic factors","volume":"28","author":"Klijn","year":"1997"},{"key":"b16-0260006","series-title":"Stroke","first-page":"3193","article-title":"Moyamoya disease in Europeans","volume":"39","author":"Kraemer","year":"2008"},{"key":"b17-0260006","series-title":"Childs Nerv Syst","first-page":"584","article-title":"Regional cerebral hemodynamics in childhood moyamoya disease","volume":"11","author":"Kuroda","year":"1995"},{"key":"b18-0260006","series-title":"Stroke","first-page":"2148","article-title":"Incidence and clinical features of disease progression in adult moyamoya disease","volume":"36","author":"Kuroda","year":"2005"},{"key":"b19-0260006","series-title":"Stroke","first-page":"272","article-title":"Cerebral hemodynamic change in the child and the adult with moyamoya disease","volume":"21","author":"Kuwabara","year":"1990"},{"key":"b20-0260006","series-title":"N Engl J Med","first-page":"445","article-title":"Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis","volume":"325","author":"North American Symptomatic Carotid Endarterectomy Trial Collaborators","year":"1991"},{"key":"b21-0260006","series-title":"Cerebrovasc Dis","first-page":"244","article-title":"The clinical features of adult unilateral moyamoya disease: does it have the same clinical characteristics as typical moyamoya disease?","volume":"26","author":"Ogata","year":"2008"},{"key":"b22-0260006","series-title":"Stroke","first-page":"1970","article-title":"Transcranial Doppler assessment of cerebrovascular reactivity in symptomatic and asymptomatic severe carotid stenosis","volume":"27","author":"Silvestrini","year":"1996"},{"key":"b23-0260006","series-title":"Stroke","first-page":"708","article-title":"Angiography of nonhemorrhagic cerebral infarction in young adults","volume":"18","author":"Smoker","year":"1987"},{"key":"b24-0260006","series-title":"Arch Neurol","first-page":"288","article-title":"Cerebrovascular \u201cmoyamoya\u201d disease: disease showing abnormal net-like vessels in base of brain","volume":"20","author":"Suzuki","year":"1969"},{"key":"b25-0260006","series-title":"Neurology","first-page":"956","article-title":"Moyamoya disease in Washington State and California","volume":"65","author":"Uchino","year":"2005"},{"key":"b26-0260006","series-title":"Stroke","first-page":"593","article-title":"Outcome of carotid artery occlusion is predicted by cerebrovascular reactivity","volume":"30","author":"Vernieri","year":"1999"},{"key":"b27-0260006","series-title":"Stroke","first-page":"1963","article-title":"Course of cerebrovascular reactivity in patients with carotid artery occlusions","volume":"25","author":"Widder","year":"1994"},{"key":"b28-0260006","series-title":"Acta Neurol Scand Suppl","first-page":"82","article-title":"Modulation of cerebral hemodynamics by surgical revascularization in patients with moyamoya disease","volume":"166","author":"Yamashita","year":"1996"},{"key":"b29-0260006","series-title":"J Nucl Med","first-page":"1992","article-title":"Significance of increased oxygen extraction fraction in five-year prognosis of major cerebral arterial occlusive disease","volume":"40","author":"Yamauchi","year":"1999"},{"key":"b30-0260006","series-title":"Arch Neurol","first-page":"1274","article-title":"Moyamoya: Indiana University Medical Center experience","volume":"58","author":"Yilmaz","year":"2001"},{"key":"b1-0260006","series-title":"Stroke","first-page":"826","article-title":"Cerebral infarction due to moyamoya disease in young adults","volume":"19","author":"Bruno","year":"1988"},{"key":"b2-0260006","series-title":"N Engl J Med","first-page":"1305","article-title":"Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis","volume":"352","author":"Chimowitz","year":"2005"},{"key":"b3-0260006","series-title":"Stroke","first-page":"1347","article-title":"Clinical features of Moyamoya disease in the United States","volume":"29","author":"Chiu","year":"1998"},{"key":"b4-0260006","series-title":"Neuroradiology","first-page":"772","article-title":"Idiopathic supraclinoid and internal carotid bifurcation steno-occlusive disease in young American adults","volume":"41","author":"Cloft","year":"1999"},{"key":"b5-0260006","series-title":"Neurology","first-page":"251","article-title":"Cerebral hemodynamic impairment: methods of measurement and association with stroke risk","volume":"53","author":"Derdeyn","year":"1999"},{"key":"b6-0260006","series-title":"Stroke","first-page":"1019","article-title":"Compensatory mechanisms for chronic cerebral hypoperfusion in patients with carotid occlusion","volume":"30","author":"Derdeyn","year":"1999"},{"key":"b7-0260006","series-title":"J Nucl Med","first-page":"1195","article-title":"Comparison of PET oxygen extraction fraction methods for the prediction of stroke risk","volume":"42","author":"Derdeyn","year":"2001"},{"key":"b8-0260006","series-title":"N Engl J Med","first-page":"1191","article-title":"Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke: results of an international randomized trial","volume":"313","author":"EC\/IC Bypass Study Group","year":"1985"},{"key":"b9-0260006","series-title":"JAMA","first-page":"1055","article-title":"Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion","volume":"280","author":"Grubb","year":"1998"},{"key":"b10-0260006","series-title":"Stroke","first-page":"1490","article-title":"Clinical features and outcome in North American adults with moyamoya phenomenon","volume":"37","author":"Hallemeier","year":"2006"},{"key":"b11-0260006","series-title":"Neuroradiology","first-page":"15","article-title":"Sequential change of hemodynamic reserve in patients with major cerebral artery occlusions or severe stenosis","volume":"34","author":"Hasegawa","year":"1992"},{"key":"b12-0260006","series-title":"Surg Neurol","first-page":"251","article-title":"Evaluation of cerebral blood flow and hemodynamic reserve in symptomatic moyamoya disease using stable Xenon-CT blood flow","volume":"44","author":"Horowitz","year":"1995"},{"key":"b13-0260006","series-title":"J Neurosurg","first-page":"843","article-title":"Cerebral circulation and oxygen metabolism in childhood moyamoya disease: a perioperative positron emission tomography study","volume":"81","author":"Ikezaki","year":"1994"},{"key":"b14-0260006","series-title":"Cerebrovasc Dis","first-page":"109","article-title":"Progression of unilateral moyamoya disease: a clinical series","volume":"22","author":"Kelly","year":"2006"},{"key":"b15-0260006","series-title":"Stroke","first-page":"2084","article-title":"Symptomatic carotid artery occlusion: a reappraisal of hemodynamic factors","volume":"28","author":"Klijn","year":"1997"},{"key":"b16-0260006","series-title":"Stroke","first-page":"3193","article-title":"Moyamoya disease in Europeans","volume":"39","author":"Kraemer","year":"2008"},{"key":"b17-0260006","series-title":"Childs Nerv Syst","first-page":"584","article-title":"Regional cerebral hemodynamics in childhood moyamoya disease","volume":"11","author":"Kuroda","year":"1995"},{"key":"b18-0260006","series-title":"Stroke","first-page":"2148","article-title":"Incidence and clinical features of disease progression in adult moyamoya disease","volume":"36","author":"Kuroda","year":"2005"},{"key":"b19-0260006","series-title":"Stroke","first-page":"272","article-title":"Cerebral hemodynamic change in the child and the adult with moyamoya disease","volume":"21","author":"Kuwabara","year":"1990"},{"key":"b20-0260006","series-title":"N Engl J Med","first-page":"445","article-title":"Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis","volume":"325","author":"North American Symptomatic Carotid Endarterectomy Trial Collaborators","year":"1991"},{"key":"b21-0260006","series-title":"Cerebrovasc Dis","first-page":"244","article-title":"The clinical features of adult unilateral moyamoya disease: does it have the same clinical characteristics as typical moyamoya disease?","volume":"26","author":"Ogata","year":"2008"},{"key":"b22-0260006","series-title":"Stroke","first-page":"1970","article-title":"Transcranial Doppler assessment of cerebrovascular reactivity in symptomatic and asymptomatic severe carotid stenosis","volume":"27","author":"Silvestrini","year":"1996"},{"key":"b23-0260006","series-title":"Stroke","first-page":"708","article-title":"Angiography of nonhemorrhagic cerebral infarction in young adults","volume":"18","author":"Smoker","year":"1987"},{"key":"b24-0260006","series-title":"Arch Neurol","first-page":"288","article-title":"Cerebrovascular \u201cmoyamoya\u201d disease: disease showing abnormal net-like vessels in base of brain","volume":"20","author":"Suzuki","year":"1969"},{"key":"b25-0260006","series-title":"Neurology","first-page":"956","article-title":"Moyamoya disease in Washington State and California","volume":"65","author":"Uchino","year":"2005"},{"key":"b26-0260006","series-title":"Stroke","first-page":"593","article-title":"Outcome of carotid artery occlusion is predicted by cerebrovascular reactivity","volume":"30","author":"Vernieri","year":"1999"},{"key":"b27-0260006","series-title":"Stroke","first-page":"1963","article-title":"Course of cerebrovascular reactivity in patients with carotid artery occlusions","volume":"25","author":"Widder","year":"1994"},{"key":"b28-0260006","series-title":"Acta Neurol Scand Suppl","first-page":"82","article-title":"Modulation of cerebral hemodynamics by surgical revascularization in patients with moyamoya disease","volume":"166","author":"Yamashita","year":"1996"},{"key":"b29-0260006","series-title":"J Nucl Med","first-page":"1992","article-title":"Significance of increased oxygen extraction fraction in five-year prognosis of major cerebral arterial occlusive disease","volume":"40","author":"Yamauchi","year":"1999"},{"key":"b30-0260006","series-title":"Arch Neurol","first-page":"1274","article-title":"Moyamoya: Indiana University Medical Center experience","volume":"58","author":"Yilmaz","year":"2001"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/26\/4\/article-pE6.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/26\/4\/article-pE6.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/26\/4\/article-pE6.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:11:10Z","timestamp":1780733470000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/26\/4\/article-pE6.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,4]]},"references-count":60,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2009.01.focus08305","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,4]]}}}