{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:08Z","timestamp":1787025728714,"version":"build-2736575974"},"reference-count":104,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:p>Extracranial-intracranial (EC-IC) arterial bypass has been used in the treatment of various neurosurgical pathologies including skull base tumors requiring sacrifice of a large intracranial artery; complex intracranial aneurysms requiring trapping; and distal revascularization, moyamoya disease, and symptomatic cerebrovascular stenoocclusive disease. The latter indication has been the subject of intense investigations in several large randomized controlled trials, most recently the Carotid Occlusion Surgery Study (COSS). In the present literature review and synthesis, the authors examine the current evidence available for EC-IC arterial bypass for the treatment of ischemic cerebrovascular disease including both extracranial carotid artery occlusive disease and intracranial atherosclerotic disease. They focus particular attention on EC-IC arterial bypass for the treatment of symptomatic hemodynamic cerebral ischemia and how lessons learned from the COSS might guide future investigations into the treatment of this disease.<\/jats:p>","DOI":"10.3171\/2013.10.focus13427","type":"journal-article","created":{"date-parts":[[2014,1,1]],"date-time":"2014-01-01T03:35:28Z","timestamp":1388547328000},"page":"E9","source":"Crossref","is-referenced-by-count":65,"title":["Extracranial-intracranial bypass for ischemic cerebrovascular disease: what have we learned from the Carotid Occlusion Surgery Study?"],"prefix":"10.3171","volume":"36","author":[{"given":"Matthew R.","family":"Reynolds","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin P.","family":"Derdeyn","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Radiology, and"},{"name":"Neurology, Washington University School of Medicine, St. Louis, Missouri; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Grubb","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Powers","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Zipfel","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Radiology, and"},{"name":"Neurology, Washington University School of Medicine, St. Louis, Missouri; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-00360009","series-title":"Neurosurgery","first-page":"557","article-title":"Extracranial-intracranial bypass for stroke-is this the end of the line or a bump in the road?","volume":"71","author":"Amin-Hanjani","year":"2012"},{"key":"b2-00360009","series-title":"J Neurosurg","first-page":"831","article-title":"Extracranial-intracranial arterial bypass for middle cerebral artery stenosis and occlusion. Operative results in 65 cases","volume":"62","author":"Andrews","year":"1985"},{"key":"b3-00360009","series-title":"Surg Neurol","first-page":"218","article-title":"Critique of the extracranial-intracranial bypass study","volume":"26","author":"Ausman","year":"1986"},{"key":"b4-00360009","series-title":"Surg Neurol","first-page":"227","article-title":"Further conclusions from the extracranial-intracranial bypass trial","volume":"26","author":"Barnett","year":"1986"},{"key":"b5-00360009","series-title":"N Engl J Med","first-page":"820","article-title":"Are the results of the extracranial-intracranial bypass trial generalizable?","volume":"316","author":"Barnett","year":"1987"},{"key":"b6-00360009","series-title":"Stroke","first-page":"454","article-title":"Reversal of focal \u201cmisery-perfusion syndrome\u201d by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography","volume":"12","author":"Baron","year":"1981"},{"key":"b7-00360009","series-title":"Stroke","first-page":"3637","article-title":"Failure of cerebral hemodynamic selection in general or of specific positron emission tomography methodology?: Carotid Occlusion Surgery Study (COSS)","volume":"42","author":"Carlson","year":"2011"},{"key":"b8-00360009","series-title":"Neurol Res","first-page":"1","article-title":"Neurosurgical extracranial-intracranial bypass for stroke: with 400 cases","volume":"5","author":"Chater","year":"1983"},{"key":"b9-00360009","series-title":"Neurology","first-page":"1488","article-title":"The warfarin-aspirin symptomatic intracranial disease study","volume":"45","author":"Chimowitz","year":"1995"},{"key":"b10-00360009","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":"b11-00360009","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":"b12-00360009","series-title":"Surg Neurol","first-page":"222","article-title":"The extracranial-intracranial bypass study","volume":"26","author":"Day","year":"1986"},{"key":"b13-00360009","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":"b14-00360009","series-title":"Skull Base","first-page":"7","article-title":"Indications for cerebral revascularization for patients with atherosclerotic carotid occlusion","volume":"15","author":"Derdeyn","year":"2005"},{"key":"b15-00360009","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":"b16-00360009","series-title":"Stroke","first-page":"e349","article-title":"Population-based study of symptomatic internal carotid artery occlusion: incidence and long-term follow-up","volume":"35","author":"Flaherty","year":"2004"},{"key":"b17-00360009","series-title":"J Neurol Neurosurg Psychiatry","first-page":"140","article-title":"Cerebral haemodynamic changes after extracranial-intracranial bypass surgery","volume":"50","author":"Gibbs","year":"1987"},{"key":"b18-00360009","series-title":"J Neurosurg","first-page":"313","article-title":"Clinical experience with extra-intracranial arterial anastomosis in 65 cases","volume":"44","author":"Gratzl","year":"1976"},{"key":"b19-00360009","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":"b20-00360009","series-title":"J Neurosurg","first-page":"25","article-title":"Surgical results of the Carotid Occlusion Surgery Study. Clinical article","volume":"118","author":"Grubb","year":"2013"},{"key":"b21-00360009","series-title":"J Neurosurg","first-page":"20","article-title":"Editorial. Carotid occlusion","volume":"118","author":"Heros","year":"2013"},{"key":"b22-00360009","series-title":"Lancet Neurol","first-page":"942","article-title":"Safety and efficacy of NA-1 in patients with iatrogenic stroke after endovascular aneurysm repair (ENACT): a phase 2, randomised, double-blind, placebo-controlled trial","volume":"11","author":"Hill","year":"2012"},{"key":"b23-00360009","series-title":"J Neurosurg","first-page":"46","article-title":"Superficial temporal-middle cerebral artery bypass: clinical pre- and postoperative angiographic correlation","volume":"69","author":"Jack","year":"1988"},{"key":"b24-00360009","series-title":"Circulation","first-page":"555","article-title":"Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis","volume":"113","author":"Kasner","year":"2006"},{"key":"b25-00360009","series-title":"J Neurosurg","first-page":"896","article-title":"The role of indirect extracranial-intracranial bypass in the treatment of symptomatic intracranial atheroocclusive disease. Clinical article","volume":"110","author":"Komotar","year":"2009"},{"key":"b26-00360009","series-title":"Circ Cardiovasc Interv","first-page":"119","article-title":"Procedural safety and potential vascular complication of endovascular recanalization for chronic cervical internal carotid artery occlusion","volume":"1","author":"Lin","year":"2008"},{"key":"b27-00360009","series-title":"Circulation","first-page":"e46","article-title":"Heart disease and stroke statistics\u20142010 update: a report from the American Heart Association","volume":"121","author":"Lloyd-Jones","year":"2010"},{"key":"b28-00360009","series-title":"Neurology","first-page":"1187","article-title":"Prospective study of symptomatic atherothrombotic intracranial stenoses: the GESICA study","volume":"66","author":"Mazighi","year":"2006"},{"key":"b29-00360009","series-title":"Acta Neurochir (Wien)","first-page":"95","article-title":"Clinical outcome of standard extracranial-intracranial bypass surgery in patients with symptomatic atherosclerotic occlusion of the internal carotid artery","volume":"146","author":"Mendelowitsch","year":"2004"},{"key":"b30-00360009","series-title":"Curr Treat Options Cardiovasc Med","first-page":"501","article-title":"Atherosclerotic carotid artery occlusion","volume":"5","author":"Powers","year":"2003"},{"key":"b31-00360009","series-title":"Neurosurgery","first-page":"E772","article-title":"Commentary: Extracranial-intracranial bypass for stroke in 2012: response to the critique of the carotid occlusion surgery study \u201cIt was d\u00e9j\u00e0 vu all over again\u201d","volume":"71","author":"Powers","year":"2012"},{"key":"b32-00360009","series-title":"JAMA","first-page":"1983","article-title":"Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial","volume":"306","author":"Powers","year":"2011"},{"key":"b33-00360009","series-title":"Neurology","first-page":"1168","article-title":"Extracranial-intracranial bypass surgery: hemodynamic and metabolic effects","volume":"34","author":"Powers","year":"1984"},{"key":"b34-00360009","series-title":"Ann Intern Med","first-page":"27","article-title":"The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation","volume":"106","author":"Powers","year":"1987"},{"key":"b35-00360009","series-title":"Clin Neurosurg","first-page":"318","article-title":"Complications of cerebral revascularization","volume":"23","author":"Reichman","year":"1976"},{"key":"b36-00360009","series-title":"J Neurosurg","first-page":"988","article-title":"Investigating the mechanisms of perioperative ischemic stroke in the Carotid Occlusion Surgery Study. Clinical article","volume":"119","author":"Reynolds","year":"2013"},{"key":"b37-00360009","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"},{"key":"b38-00360009","series-title":"Neurosurgery","first-page":"79","article-title":"Extracranial-intracranial (EC-IC) arterial bypass: past performance and current concepts","volume":"3","author":"Samson","year":"1978"},{"key":"b39-00360009","series-title":"Stroke","first-page":"609","article-title":"Effects of extra-intracranial arterial bypass on cerebral blood flow and oxygen metabolism in humans","volume":"16","author":"Samson","year":"1985"},{"key":"b40-00360009","series-title":"Acta Neurochir (Wien)","first-page":"938","article-title":"Long-term evaluation of EC-IC bypass patency","volume":"138","author":"Schick","year":"1996"},{"key":"b41-00360009","series-title":"J Neurosurg","first-page":"236","article-title":"Improvement of cerebrovascular reserve capacity by ECIC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia","volume":"81","author":"Schmiedek","year":"1994"},{"key":"b42-00360009","series-title":"N Engl J Med","first-page":"814","article-title":"Was the international randomized trial of extracranial-intracranial arterial bypass representative of the population at risk?","volume":"316","author":"Sundt","year":"1987"},{"key":"b43-00360009","series-title":"Mayo Clinic Proc","first-page":"230","article-title":"Results, complications, and follow-up of 415 bypass operations for occlusive disease of the carotid system","volume":"60","author":"Sundt","year":"1985"},{"key":"b44-00360009","series-title":"J Neurosurg","first-page":"563","article-title":"Endovascular recanalization of the completely occluded internal carotid artery using a flow reversal system at the subacute to chronic stage. Clinical article","volume":"112","author":"Terada","year":"2010"},{"key":"b45-00360009","series-title":"J Clin Neurosci","first-page":"1013","article-title":"Superficial temporal artery-middle cerebral artery bypass for ischemic atherosclerotic middle cerebral artery disease","volume":"16","author":"Tsai","year":"2009"},{"key":"b46-00360009","series-title":"Neurosurgery","first-page":"787","article-title":"Results of extracranial-intracranial arterial bypass for intracranial internal carotid artery stenosis: review of 105 cases","volume":"15","author":"Weinstein","year":"1984"},{"key":"b47-00360009","series-title":"Mayo Clinic Proc","first-page":"21","article-title":"Long-term mortality and stroke morbidity after superficial temporal artery-middle cerebral artery bypass operation","volume":"60","author":"Whisnant","year":"1985"},{"key":"b48-00360009","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 diseases","volume":"40","author":"Yamauchi","year":"1999"},{"key":"b49-00360009","series-title":"Microsurgery Applied to Neurosurgery","author":"Ya\u015fargil","year":"1969"},{"key":"b50-00360009","series-title":"Neurosurgery","first-page":"22","article-title":"Results of microsurgical extraintracranial arterial bypass in the treatment of cerebral ischemia","volume":"1","author":"Ya\u015fargil","year":"1977"},{"key":"b51-00360009","series-title":"J Neurosurg","first-page":"483","article-title":"Increased stroke risk predicted by compromised cerebral blood flow reactivity","volume":"79","author":"Yonas","year":"1993"},{"key":"b52-00360009","series-title":"Bull Schweiz Akad Med Wiss","first-page":"209","article-title":"[Improvement in brain circulation by microsurgical bypass anastomoses.]","volume":"36","author":"Zumstein","year":"1980"},{"key":"b1-00360009","series-title":"Neurosurgery","first-page":"557","article-title":"Extracranial-intracranial bypass for stroke-is this the end of the line or a bump in the road?","volume":"71","author":"Amin-Hanjani","year":"2012"},{"key":"b2-00360009","series-title":"J Neurosurg","first-page":"831","article-title":"Extracranial-intracranial arterial bypass for middle cerebral artery stenosis and occlusion. Operative results in 65 cases","volume":"62","author":"Andrews","year":"1985"},{"key":"b3-00360009","series-title":"Surg Neurol","first-page":"218","article-title":"Critique of the extracranial-intracranial bypass study","volume":"26","author":"Ausman","year":"1986"},{"key":"b4-00360009","series-title":"Surg Neurol","first-page":"227","article-title":"Further conclusions from the extracranial-intracranial bypass trial","volume":"26","author":"Barnett","year":"1986"},{"key":"b5-00360009","series-title":"N Engl J Med","first-page":"820","article-title":"Are the results of the extracranial-intracranial bypass trial generalizable?","volume":"316","author":"Barnett","year":"1987"},{"key":"b6-00360009","series-title":"Stroke","first-page":"454","article-title":"Reversal of focal \u201cmisery-perfusion syndrome\u201d by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography","volume":"12","author":"Baron","year":"1981"},{"key":"b7-00360009","series-title":"Stroke","first-page":"3637","article-title":"Failure of cerebral hemodynamic selection in general or of specific positron emission tomography methodology?: Carotid Occlusion Surgery Study (COSS)","volume":"42","author":"Carlson","year":"2011"},{"key":"b8-00360009","series-title":"Neurol Res","first-page":"1","article-title":"Neurosurgical extracranial-intracranial bypass for stroke: with 400 cases","volume":"5","author":"Chater","year":"1983"},{"key":"b9-00360009","series-title":"Neurology","first-page":"1488","article-title":"The warfarin-aspirin symptomatic intracranial disease study","volume":"45","author":"Chimowitz","year":"1995"},{"key":"b10-00360009","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":"b11-00360009","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":"b12-00360009","series-title":"Surg Neurol","first-page":"222","article-title":"The extracranial-intracranial bypass study","volume":"26","author":"Day","year":"1986"},{"key":"b13-00360009","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":"b14-00360009","series-title":"Skull Base","first-page":"7","article-title":"Indications for cerebral revascularization for patients with atherosclerotic carotid occlusion","volume":"15","author":"Derdeyn","year":"2005"},{"key":"b15-00360009","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":"b16-00360009","series-title":"Stroke","first-page":"e349","article-title":"Population-based study of symptomatic internal carotid artery occlusion: incidence and long-term follow-up","volume":"35","author":"Flaherty","year":"2004"},{"key":"b17-00360009","series-title":"J Neurol Neurosurg Psychiatry","first-page":"140","article-title":"Cerebral haemodynamic changes after extracranial-intracranial bypass surgery","volume":"50","author":"Gibbs","year":"1987"},{"key":"b18-00360009","series-title":"J Neurosurg","first-page":"313","article-title":"Clinical experience with extra-intracranial arterial anastomosis in 65 cases","volume":"44","author":"Gratzl","year":"1976"},{"key":"b19-00360009","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":"b20-00360009","series-title":"J Neurosurg","first-page":"25","article-title":"Surgical results of the Carotid Occlusion Surgery Study. Clinical article","volume":"118","author":"Grubb","year":"2013"},{"key":"b21-00360009","series-title":"J Neurosurg","first-page":"20","article-title":"Editorial. Carotid occlusion","volume":"118","author":"Heros","year":"2013"},{"key":"b22-00360009","series-title":"Lancet Neurol","first-page":"942","article-title":"Safety and efficacy of NA-1 in patients with iatrogenic stroke after endovascular aneurysm repair (ENACT): a phase 2, randomised, double-blind, placebo-controlled trial","volume":"11","author":"Hill","year":"2012"},{"key":"b23-00360009","series-title":"J Neurosurg","first-page":"46","article-title":"Superficial temporal-middle cerebral artery bypass: clinical pre- and postoperative angiographic correlation","volume":"69","author":"Jack","year":"1988"},{"key":"b24-00360009","series-title":"Circulation","first-page":"555","article-title":"Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis","volume":"113","author":"Kasner","year":"2006"},{"key":"b25-00360009","series-title":"J Neurosurg","first-page":"896","article-title":"The role of indirect extracranial-intracranial bypass in the treatment of symptomatic intracranial atheroocclusive disease. Clinical article","volume":"110","author":"Komotar","year":"2009"},{"key":"b26-00360009","series-title":"Circ Cardiovasc Interv","first-page":"119","article-title":"Procedural safety and potential vascular complication of endovascular recanalization for chronic cervical internal carotid artery occlusion","volume":"1","author":"Lin","year":"2008"},{"key":"b27-00360009","series-title":"Circulation","first-page":"e46","article-title":"Heart disease and stroke statistics\u20142010 update: a report from the American Heart Association","volume":"121","author":"Lloyd-Jones","year":"2010"},{"key":"b28-00360009","series-title":"Neurology","first-page":"1187","article-title":"Prospective study of symptomatic atherothrombotic intracranial stenoses: the GESICA study","volume":"66","author":"Mazighi","year":"2006"},{"key":"b29-00360009","series-title":"Acta Neurochir (Wien)","first-page":"95","article-title":"Clinical outcome of standard extracranial-intracranial bypass surgery in patients with symptomatic atherosclerotic occlusion of the internal carotid artery","volume":"146","author":"Mendelowitsch","year":"2004"},{"key":"b30-00360009","series-title":"Curr Treat Options Cardiovasc Med","first-page":"501","article-title":"Atherosclerotic carotid artery occlusion","volume":"5","author":"Powers","year":"2003"},{"key":"b31-00360009","series-title":"Neurosurgery","first-page":"E772","article-title":"Commentary: Extracranial-intracranial bypass for stroke in 2012: response to the critique of the carotid occlusion surgery study \u201cIt was d\u00e9j\u00e0 vu all over again\u201d","volume":"71","author":"Powers","year":"2012"},{"key":"b32-00360009","series-title":"JAMA","first-page":"1983","article-title":"Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial","volume":"306","author":"Powers","year":"2011"},{"key":"b33-00360009","series-title":"Neurology","first-page":"1168","article-title":"Extracranial-intracranial bypass surgery: hemodynamic and metabolic effects","volume":"34","author":"Powers","year":"1984"},{"key":"b34-00360009","series-title":"Ann Intern Med","first-page":"27","article-title":"The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation","volume":"106","author":"Powers","year":"1987"},{"key":"b35-00360009","series-title":"Clin Neurosurg","first-page":"318","article-title":"Complications of cerebral revascularization","volume":"23","author":"Reichman","year":"1976"},{"key":"b36-00360009","series-title":"J Neurosurg","first-page":"988","article-title":"Investigating the mechanisms of perioperative ischemic stroke in the Carotid Occlusion Surgery Study. 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Clinical article","volume":"112","author":"Terada","year":"2010"},{"key":"b45-00360009","series-title":"J Clin Neurosci","first-page":"1013","article-title":"Superficial temporal artery-middle cerebral artery bypass for ischemic atherosclerotic middle cerebral artery disease","volume":"16","author":"Tsai","year":"2009"},{"key":"b46-00360009","series-title":"Neurosurgery","first-page":"787","article-title":"Results of extracranial-intracranial arterial bypass for intracranial internal carotid artery stenosis: review of 105 cases","volume":"15","author":"Weinstein","year":"1984"},{"key":"b47-00360009","series-title":"Mayo Clinic Proc","first-page":"21","article-title":"Long-term mortality and stroke morbidity after superficial temporal artery-middle cerebral artery bypass operation","volume":"60","author":"Whisnant","year":"1985"},{"key":"b48-00360009","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 diseases","volume":"40","author":"Yamauchi","year":"1999"},{"key":"b49-00360009","series-title":"Microsurgery Applied to Neurosurgery","author":"Ya\u015fargil","year":"1969"},{"key":"b50-00360009","series-title":"Neurosurgery","first-page":"22","article-title":"Results of microsurgical extraintracranial arterial bypass in the treatment of cerebral ischemia","volume":"1","author":"Ya\u015fargil","year":"1977"},{"key":"b51-00360009","series-title":"J Neurosurg","first-page":"483","article-title":"Increased stroke risk predicted by compromised cerebral blood flow reactivity","volume":"79","author":"Yonas","year":"1993"},{"key":"b52-00360009","series-title":"Bull Schweiz Akad Med Wiss","first-page":"209","article-title":"[Improvement in brain circulation by microsurgical bypass anastomoses.]","volume":"36","author":"Zumstein","year":"1980"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/36\/1\/article-pE9.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/36\/1\/article-pE9.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/36\/1\/article-pE9.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:37:42Z","timestamp":1777711062000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/36\/1\/article-pE9.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,1]]},"references-count":104,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2013.10.focus13427","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,1]]}}}