{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T19:05:32Z","timestamp":1779044732373,"version":"3.51.4"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,7]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Symptomatic intracranial arterial stenoses have a high rate of recurrent stroke despite medical and endovascular treatments. The authors present clinical and angiographic quantitative outcomes of indirect revascularization for patients with symptomatic intracranial stenosis.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Patients treated for symptomatic intracranial arterial stenosis by indirect revascularization were included. The patient population comprised those in whom medical management had failed and for whom endovascular therapy was unsuitable or had failed. Patients underwent encephaloduroarteriosynangiosis (EDAS) with or without bur holes. Preoperative and postoperative angiograms were evaluated for change in caliber of extracranial blood vessels (superficial temporal artery [STA] and middle meningeal artery [MMA]) and for evidence of neovascularization.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Thirteen patients underwent EDAS. Ischemic symptoms ceased within the follow-up period in all patients, returning in a delayed fashion in only 2. No other patients had recurrent TIAs or strokes after the initial postoperative period. Donor blood vessels increased in size relative to preoperative sizes in all but 1 case (average increase of 52% for proximal STA [p = 0.01], 74% for midpoint of STA [p = 0.01], and 84% for the MMA [p = 0.02]). In addition, 8 of 11 patients demonstrated direct spontaneous anastomoses from extracranial to middle cerebral artery branches, and all patients demonstrated angiographic evidence of vascular blush and\/or new branches from the STA and\/or MMA.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Indirect revascularization appears to be a safe and effective method to improve blood flow to ischemic brain due to intracranial arterial stenosis. Neovascularization and enlargement of the branches of the ECA were observed in all patients and correlated with improvement in ischemic symptoms. Indirect revascularization is an option for patients in whom medical therapy has failed and who are not suitable for endovascular treatment.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.4.jns111103","type":"journal-article","created":{"date-parts":[[2012,5,4]],"date-time":"2012-05-04T15:30:39Z","timestamp":1336145439000},"page":"94-102","source":"Crossref","is-referenced-by-count":28,"title":["Indirect revascularization for nonmoyamoya intracranial arterial stenoses: clinical and angiographic outcomes"],"prefix":"10.3171","volume":"117","author":[{"given":"Joshua R.","family":"Dusick","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David S.","family":"Liebeskind","sequence":"additional","affiliation":[{"name":"Neurology, and"},{"name":"UCLA Stroke Center, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey L.","family":"Saver","sequence":"additional","affiliation":[{"name":"Neurology, and"},{"name":"UCLA Stroke Center, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil A.","family":"Martin","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nestor R.","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Radiology, David Geffen School of Medicine at UCLA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns111103","series-title":"Pediatr Neurosurg","first-page":"26","article-title":"Pial synangiosis for moyamoya syndrome in children","volume":"23","author":"Adelson","year":"1995"},{"issue":"1 Suppl","key":"b2-jns111103","series-title":"Stroke","first-page":"S20","article-title":"Intracranial atherosclerosis: current concepts","volume":"42","author":"Arenillas","year":"2011"},{"key":"b3-jns111103","series-title":"J Neurosurg","first-page":"771","article-title":"Changes in intracranial stenotic lesions after extracranial-intracranial bypass surgery","volume":"60","author":"Awad","year":"1984"},{"key":"b4-jns111103","series-title":"N Engl J Med","first-page":"993","article-title":"Stenting versus aggressive medical therapy for intracranial arterial stenosis","volume":"365","author":"Chimowitz","year":"2011"},{"key":"b5-jns111103","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":"b6-jns111103","series-title":"Neurosurgery","first-page":"34","article-title":"Clinical and angiographic outcomes from indirect revascularization surgery for Moyamoya disease in adults and children: a review of 63 procedures","volume":"68","author":"Dusick","year":"2011"},{"key":"b7-jns111103","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":"b8-jns111103","series-title":"Stroke","first-page":"1999","article-title":"Causes and severity of ischemic stroke in patients with symptomatic intracranial arterial stenosis","volume":"40","author":"Famakin","year":"2009"},{"key":"b9-jns111103","series-title":"Stroke","first-page":"e109","article-title":"Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke","volume":"34","author":"Higashida","year":"2003"},{"key":"b10-jns111103","series-title":"J Neurosurg","first-page":"896","article-title":"The role of indirect extracranial-intracranial bypass in the treatment of symptomatic intracranial atheroocclusive disease. 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Ischemia","volume":"66","author":"Liebeskind","year":"2009"},{"key":"b13-jns111103","series-title":"J Cereb Blood Flow Metab","first-page":"1293","article-title":"Collateral circulation in symptomatic intracranial atherosclerosis","volume":"31","author":"Liebeskind","year":"2011"},{"key":"b14-jns111103","series-title":"Ann Neurol","first-page":"963","article-title":"Collaterals dramatically alter stroke risk in intracranial atherosclerosis","volume":"69","author":"Liebeskind","year":"2011"},{"issue":"5","key":"b15-jns111103","series-title":"Neurosurg Focus","first-page":"e4","article-title":"Multiple combined indirect procedure for the surgical treatment of children with moyamoya disease. A comparison with single indirect anastomosis and direct anastomosis","volume":"5","author":"Matsushima","year":"1998"},{"key":"b16-jns111103","series-title":"Neurosurgery","first-page":"401","article-title":"Surgical treatment of moyamoya disease in pediatric patients\u2014 comparison between the results of indirect and direct revascularization procedures","volume":"31","author":"Matsushima","year":"1992"},{"key":"b17-jns111103","series-title":"Bull Tokyo Med Dent Univ","first-page":"7","article-title":"Angiographic demonstration of cerebral revascularization after encephalo-duro-arterio-synangiosis (EDAS) performed on pediatric moyamoya patients","volume":"29","author":"Matsushima","year":"1982"},{"key":"b18-jns111103","series-title":"Clinical Alert: Angioplasty combined with stenting plus aggressive medical therapy vs. aggressive medical therapy alone for intracranial arterial stenosis: NINDS stops trial enrollment due to a higher risk of stroke and death in the stented group","author":"National Institutes of Health","year":"2011"},{"key":"b19-jns111103","article-title":"Results of the Carotid Occlusion Surgery Study (COSS)","author":"Powers"},{"issue":"Suppl 1","key":"b20-jns111103","series-title":"J Neuroimaging","first-page":"1S","article-title":"Consensus conference on intracranial atherosclerotic disease: rationale, methodology, and results","volume":"19","author":"Qureshi","year":"2009"},{"key":"b21-jns111103","series-title":"Stroke","first-page":"14","article-title":"Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study","volume":"26","author":"Sacco","year":"1995"},{"issue":"6 Suppl","key":"b22-jns111103","series-title":"J Neurosurg","first-page":"437","article-title":"Multiple bur hole surgery for the treatment of moyamoya disease in children","volume":"105","author":"Sainte-Rose","year":"2006"},{"issue":"2 Suppl Pediatrics","key":"b23-jns111103","series-title":"J Neurosurg","first-page":"142","article-title":"Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis","volume":"100","author":"Scott","year":"2004"},{"issue":"4","key":"b24-jns111103","series-title":"Neurosurg Focus","first-page":"E8","article-title":"Optimal surgical treatment for moyamoya disease in adults: direct versus indirect bypass","volume":"26","author":"Starke","year":"2009"},{"key":"b25-jns111103","series-title":"Stroke","first-page":"719","article-title":"Racial differences in vascular risk factors and outcomes of patients with intracranial atherosclerotic arterial stenosis","volume":"40","author":"Waddy","year":"2009"},{"key":"b26-jns111103","series-title":"Stroke","first-page":"2055","article-title":"Gender differences in outcomes among patients with symptomatic intracranial arterial stenosis","volume":"38","author":"Williams","year":"2007"},{"key":"b27-jns111103","series-title":"Neuroradiology","first-page":"318","article-title":"Childhood moyamoya disease before and after encephalo-duro-arterio-synangiosis: an angiographic study","volume":"34","author":"Yamada","year":"1992"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/117\/1\/article-p94.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/117\/1\/article-p94.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/117\/1\/article-p94.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T23:27:46Z","timestamp":1679873266000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/117\/1\/article-p94.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2012,7]]},"references-count":27,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2012.4.jns111103","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,7]]}}}