{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:31:16Z","timestamp":1792693876486,"version":"4.5.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2016,6]]},"abstract":"\nOBJECT<\/jats:title>\nMoyamoya disease (MMD) is a progressive disease that can cause recurrent stroke. The authors undertook this retrospective case-control study with a large sample size in an attempt to assess the efficacy of direct or combined revascularization surgery for ischemia in adults with MMD.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nThe authors investigated cases involving patients with moyamoya disease presenting with ischemia who visited Seoul National University Bundang Hospital and Seoul National University Hospital between 2000 and 2014. Among 441 eligible patients, 301 underwent revascularization surgery and 140 were treated conservatively. Variables evaluated included age at diagnosis, sex, surgical record, Suzuki stage, and occurrence of stroke. Patients were stratified into 2 groups based on whether or not they had undergone revascularization surgery. Actuarial 1-, 5-, and 10-year stroke rates were calculated using the life table method. Risk factor analysis for 5-year stroke occurrence was conducted with multivariate regression.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nOf the 441 patients, 301 had been surgically treated (revascularization group) and 140 had not (control group). The mean follow-up durations were 45 and 77 months, respectively. The actuarial 10-year cumulative incidence rate for any kind of stroke was significantly lower in the revascularization group (9.4%) than in the control group (19.6%) (p = 0.041); the relative risk reduction (RRR) was also superior (52.0%) in the revascularization group, and the number needed to treat was 10. The 10-year rate of ischemic stroke was greater (13.3%) in the control group than in the revascularization group (3.9%) (p = 0.019). The RRR for ischemic stroke in the revascularization group was 70.7%, and the number needed to treat was 11. However, the actuarial 1- and 5-year rates of ischemic stroke did not significantly differently between the groups. Overall, revascularization surgery was shown to be an independent protective factor, as revealed by multivariate analysis.<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nDirect or combined revascularization for patients with adult-onset moyamoya disease presenting with ischemia can prevent further stroke.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.6.jns151105","type":"journal-article","created":{"date-parts":[[2015,12,4]],"date-time":"2015-12-04T13:47:20Z","timestamp":1449236840000},"page":"1788-1793","source":"Crossref","is-referenced-by-count":100,"title":["Stroke prevention by direct revascularization for patients with adult-onset moyamoya disease presenting with ischemia"],"prefix":"10.3171","volume":"124","author":[{"given":"Tackeun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Wan","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O-Ki","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyojun","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong Eun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun-Seung","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won-Sang","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Seung","family":"Bang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1-jns151105","series-title":"Cochrane Database Syst Rev","first-page":"CD001927","article-title":"Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks","author":"Aguilar"},{"key":"b2-jns151105","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1227\/NEU.0b013e3182333c47","article-title":"Quantitative angiographic comparison with the OSIRIS program between the direct and indirect revascularization modalities in adult moyamoya disease","volume":"70","author":"Bang","year":"2012"},{"key":"b3-jns151105","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1161\/01.STR.29.7.1347","article-title":"Clinical features of moyamoya disease in the United States","volume":"29","author":"Chiu","year":"1998"},{"key":"b4-jns151105","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"82","DOI":"10.3171\/2014.9.JNS132281","article-title":"The natural clinical course of hemodynamically stable adult moyamoya disease","volume":"122","author":"Cho","year":"2015"},{"key":"b5-jns151105","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"3025","DOI":"10.1161\/STROKEAHA.114.005624","article-title":"Long-term outcomes after combined revascularization surgery in adult moyamoya disease","volume":"45","author":"Cho","year":"2014"},{"key":"b6-jns151105","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1161\/STROKEAHA.111.621300","article-title":"Moyamoya disease in China: its clinical features and outcomes","volume":"43","author":"Duan","year":"2012"},{"key":"b7-jns151105","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1056\/NEJM198511073131904","article-title":"Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. 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