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Group A included 10 patients who underwent repeat bypass surgery for anterior circulation due to insufficient revascularization on the ipsilateral side. Group B included 10 patients who underwent repeat bypass surgery for posterior circulation due to the involvement of the posterior cerebral artery (PCA) after successful initial surgery for anterior circulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Preoperative symptoms included headache in 3 patients, transient ischemic attack in 10, cerebral infarction in 3, and intracranial hemorrhage in 4 patients. Intervals between the initial bypass surgery and repeat bypass surgery were 0.3\u201330 years (median 3 years). In group A, superficial temporal artery to middle cerebral artery (MCA) anastomosis and indirect bypass were performed on 7 hemispheres. Only indirect bypass was performed on 3 hemispheres because of the lack of suitable donor or recipient arteries. In group B, occipital artery (OA) to PCA anastomosis and indirect bypass were conducted on 4 hemispheres, and OA-MCA anastomosis and indirect bypass on 1 hemisphere. Only indirect bypass was conducted on 7 hemispheres because of the lack of suitable recipient arteries. All 22 repeat bypass surgeries were successfully conducted. During follow-up periods (median 4 years), none of the patients suffered repeat stroke except 1 patient who died of recurrent intracerebral hemorrhage 3 years after repeat bypass surgery for anterior circulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Repeat bypass surgery was feasible and effective to reduce further incidence of headache attack, transient ischemic attack, and ischemic\/hemorrhagic stroke in moyamoya disease patients. Through precise radiological analysis, surgical procedures should be planned to yield maximal therapeutic effects.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.3.jns181979","type":"journal-article","created":{"date-parts":[[2019,5,31]],"date-time":"2019-05-31T23:22:40Z","timestamp":1559344960000},"page":"1889-1899","source":"Crossref","is-referenced-by-count":10,"title":["Strategy and effect of repeat bypass surgery for anterior\/posterior circulation in refractory moyamoya disease"],"prefix":"10.3171","volume":"132","author":[{"given":"Haruto","family":"Uchino","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and"},{"name":"Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daina","family":"Kashiwazaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Akioka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Koh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoya","family":"Kuwayama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyohiro","family":"Houkin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Kuroda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and"},{"name":"Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Stroke Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.03.053","article-title":"Surgical revascularization in North American adults with moyamoya phenomenon: long-term angiographic follow-up","volume":"24","author":"Arias EJ","year":"2015","unstructured":"Arias EJ, Dunn GP, Washington CW, Derdeyn CP, Chicoine MR, Grubb RL Jr, : Surgical revascularization in North American adults with moyamoya phenomenon: long-term angiographic follow-up. 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