{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:34:25Z","timestamp":1792409665990,"version":"4.4.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Extracranial-intracranial (EC-IC) bypass has been well described in chronic vaso-occlusive cerebrovascular diseases, including both moyamoya disease (MMD) and atherosclerotic disease (AD). This study aimed to compare factors associated with bypass occlusion between these two diseases.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>An institutional database of 357 patients with intracranial bypass procedures performed between August 2001 and May 2022 was retrospectively reviewed. Patients with MMD and AD were selected for study. Baseline characteristics, surgical technique, and flow-related measurements were compared in relation to the outcome of bypass occlusion.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 232 patients met inclusion criteria (AD, n = 108; MMD, n = 124). The average age and sex differed significantly between groups (AD 57.2 years, 56.5% male; MMD 36.6 years, 31.5% male; p &lt; 0.001). The modified Rankin Scale scores at surgery and at follow-up were higher in the AD group (p = 0.004 and p &lt; 0.001, respectively), showing a slightly worse baseline functional status, and higher rates of stroke were observed in the AD group by last follow-up (p = 0.005). Patients with AD also were more likely to require an interpositional graft (p &lt; 0.001). At last follow-up, rates of occlusion did not differ between AD and MMD groups (25.2% vs 25.4%, respectively). Of occluded bypasses, the AD group had more occlusions within 1 week compared to MMD (51.9% vs 35.5%, p = 0.176), although the difference was not significant. In patients with more than 1 year of follow-up and in those with more than 2 years of follow-up, MMD tended to have higher rates of occlusion (31.2% vs 26.1% [p = 0.558], and 26.4% vs 20.7% [p = 0.564]). Flow measurements did not differ between AD and MMD groups, but in subgroup analyses of patients with AD and those with MMD, both bypass flow and cut flow index predicted occlusion in both groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Despite different disease etiologies treated with bypass, rates of occlusion at last follow-up did not vary between groups, although short-term follow-up would suggest earlier bypass failure in AD, and extended follow-up trended toward higher occlusion rates in MMD. Additionally, patients with AD were more likely to have further occurrences of stroke by last follow-up. Importantly, the bypass flow and cut flow index at the time of surgery predicted occlusion in both AD and MMD.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.6.jns2414","type":"journal-article","created":{"date-parts":[[2024,9,21]],"date-time":"2024-09-21T01:33:24Z","timestamp":1726882404000},"page":"1-6","source":"Crossref","is-referenced-by-count":4,"title":["Does disease etiology matter in long-term patency in extracranial-intracranial bypass?"],"prefix":"10.3171","author":[{"given":"Laura Stone","family":"McGuire","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Illinois at Chicago, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana","family":"Abou-Mrad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Illinois at Chicago, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gursant","family":"Atwal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Illinois at Chicago, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sepideh","family":"Amin-Hanjani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fady T.","family":"Charbel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Illinois at Chicago, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Stroke","first-page":"1415","article-title":"Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial","volume":"45","author":"Miyamoto S","year":"2014","unstructured":"Miyamoto S, Yoshimoto T, Hashimoto N,  Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke. 2014;45(5):1415\u20131421."},{"issue":"2","key":"b2","series-title":"Stroke","first-page":"476","article-title":"Surgical management of moyamoya disease","volume":"49","author":"Acker G","year":"2018","unstructured":"Acker G, Fekonja L, Vajkoczy P. Surgical management of moyamoya disease. Stroke. 2018;49(2):476\u2013482."},{"issue":"3","key":"b3","series-title":"J Neurosurg","first-page":"793","article-title":"Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults","volume":"128","author":"Jeon JP","year":"2018","unstructured":"Jeon JP, Kim JE, Cho WS, Bang JS, Son YJ, Oh CW. Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults. J Neurosurg. 2018;128(3):793\u2013799."},{"issue":"19","key":"b4","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","year":"1985","unstructured":"EC\/IC Bypass Study Group. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med. 1985;313(19):1191\u20131200."},{"issue":"18","key":"b5","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 WJ","year":"2011","unstructured":"Powers WJ, Clarke WR, Grubb RL Jr, Videen TO, Adams HP Jr, Derdeyn CP. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA. 2011;306(18):1983\u20131992."},{"issue":"2","key":"b6","series-title":"J Neurosurg","first-page":"236","article-title":"Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia","volume":"81","author":"Schmiedek P","year":"1994","unstructured":"Schmiedek P, Piepgras A, Leinsinger G, Kirsch CM, Einh\u00fcpl K. Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg. 1994;81(2):236\u2013244."},{"issue":"3","key":"b7","series-title":"Neurosurgery","first-page":"557","article-title":"Extracranial-intracranial bypass for stroke\u2014is this the end of the line or a bump in the road?","volume":"71","author":"Amin-Hanjani S","year":"2012","unstructured":"Amin-Hanjani S, Barker FG II, Charbel FT, Connolly ES Jr, Morcos JJ, Thompson BG. Extracranial-intracranial bypass for stroke\u2014is this the end of the line or a bump in the road? Neurosurgery. 2012;71(3):557\u2013561."},{"issue":"12","key":"b8","series-title":"JAMA","first-page":"1055","article-title":"Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion","volume":"280","author":"Grubb RL Jr","year":"1998","unstructured":"Grubb RL Jr, Derdeyn CP, Fritsch SM,  Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA. 1998;280(12):1055\u20131060."},{"issue":"6","key":"b9","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 BT","year":"1985","unstructured":"Andrews BT, Chater NL, Weinstein PR. Extracranial-intracranial arterial bypass for middle cerebral artery stenosis and occlusion. Operative results in 65 cases. J Neurosurg. 1985;62(6):831\u2013838."},{"issue":"1","key":"b10","series-title":"Acta Neurochir (Wien)","first-page":"77","article-title":"Clinical significance of STA-MCA double anastomosis for hemodynamic compromise in post-JET\/COSS era","volume":"156","author":"Kuroda S","year":"2014","unstructured":"Kuroda S, Kawabori M, Hirata K,  Clinical significance of STA-MCA double anastomosis for hemodynamic compromise in post-JET\/COSS era. Acta Neurochir (Wien). 2014;156(1):77\u201383."},{"issue":"2","key":"b11","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Cerebral revascularization after the Carotid Occlusion Surgery Study: what candidates remain, and can we do better?","volume":"46","author":"White TG","year":"2019","unstructured":"White TG, Abou-Al-Shaar H, Park J, Katz J, Langer DJ, Dehdashti AR. Cerebral revascularization after the Carotid Occlusion Surgery Study: what candidates remain, and can we do better? Neurosurg Focus. 2019;46(2):E3."},{"key":"b12","series-title":"World Neurosurg","first-page":"e609","article-title":"Rescue cerebral revascularization in patients with progressive steno-occlusive ischemia of the anterior intracranial circulation","volume":"133","author":"Steinberg JA","year":"2020","unstructured":"Steinberg JA, Rennert RC, Ravina K, Strickland BA, Russin JJ. Rescue cerebral revascularization in patients with progressive steno-occlusive ischemia of the anterior intracranial circulation. World Neurosurg. 2020;133:e609\u2013e618."},{"issue":"5","key":"b13","series-title":"Oper Neurosurg (Hagerstown)","first-page":"444","article-title":"Superficial temporal artery to middle cerebral artery cranial bypass for nonmoyamoya steno-occlusive disease in patients who failed optimal medical treatment: a case series","volume":"20","author":"Haynes J","year":"2021","unstructured":"Haynes J, Kronenburg A, Raz E,  Superficial temporal artery to middle cerebral artery cranial bypass for nonmoyamoya steno-occlusive disease in patients who failed optimal medical treatment: a case series. Oper Neurosurg (Hagerstown). 2021;20(5):444\u2013455."},{"key":"b14","series-title":"World Neurosurg","first-page":"199","article-title":"Extracranial-intracranial cerebral revascularization for atherosclerotic vessel occlusion: an updated systematic review of the literature","volume":"173","author":"Nguyen VN","year":"2023","unstructured":"Nguyen VN, Motiwala M, Parikh K,  Extracranial-intracranial cerebral revascularization for atherosclerotic vessel occlusion: an updated systematic review of the literature. World Neurosurg. 2023;173:199\u2013207.e8."},{"issue":"5","key":"b15","series-title":"Neurol Res","first-page":"439","article-title":"Ultrasonic perivascular flow probe: technique and application in neurosurgery","volume":"20","author":"Charbel FT","year":"1998","unstructured":"Charbel FT, Hoffman WE, Misra M, Ostergren L. Ultrasonic perivascular flow probe: technique and application in neurosurgery. Neurol Res. 1998;20(5):439\u2013442."},{"key":"b16","article-title":"Flow-Assisted Aneurysm Surgery\u2013Cerebral Aneurysm Handbook","year":"2004","unstructured":"Charbel FT, ed. Flow-Assisted Aneurysm Surgery\u2013Cerebral Aneurysm Handbook. Transonic Systems; 2004."},{"issue":"5","key":"b17","series-title":"Clin Physiol","first-page":"547","article-title":"Volume blood flow measurements with a transit time flowmeter: an in vivo and in vitro variability and validation study","volume":"13","author":"Lundell A","year":"1993","unstructured":"Lundell A, Bergqvist D, Mattsson E, Nilsson B. Volume blood flow measurements with a transit time flowmeter: an in vivo and in vitro variability and validation study. Clin Physiol. 1993;13(5):547\u2013557."},{"issue":"6","key":"b18","series-title":"Acta Neurochir (Wien)","first-page":"1021","article-title":"Flow replacement bypass for aneurysms: decision-making using intraoperative blood flow measurements","volume":"152","author":"Amin-Hanjani S","year":"2010","unstructured":"Amin-Hanjani S, Alaraj A, Charbel FT. Flow replacement bypass for aneurysms: decision-making using intraoperative blood flow measurements. Acta Neurochir (Wien). 2010;152(6):1021\u20131032."},{"issue":"1 Suppl","key":"b19","series-title":"Neurosurgery","first-page":"75","article-title":"The cut flow index: an intraoperative predictor of the success of extracranial-intracranial bypass for occlusive cerebrovascular disease","volume":"56","author":"Amin-Hanjani S","year":"2005","unstructured":"Amin-Hanjani S, Du X, Mlinarevich N, Meglio G, Zhao M, Charbel FT. The cut flow index: an intraoperative predictor of the success of extracranial-intracranial bypass for occlusive cerebrovascular disease. Neurosurgery. 2005;56(1 Suppl):75\u201385."},{"issue":"5","key":"b20","series-title":"J Neurosurg","first-page":"1396","article-title":"The cut flow index revisited: utility of intraoperative blood flow measurements in extracranial-intracranial bypass surgery for ischemic cerebrovascular disease","volume":"133","author":"Stapleton CJ","year":"2019","unstructured":"Stapleton CJ, Atwal GS, Hussein AE, Amin-Hanjani S, Charbel FT. The cut flow index revisited: utility of intraoperative blood flow measurements in extracranial-intracranial bypass surgery for ischemic cerebrovascular disease. J Neurosurg. 2019;133(5):1396\u20131400."},{"issue":"6","key":"b21","series-title":"Magn Reson Imaging","first-page":"697","article-title":"Improved phase-contrast flow quantification by three-dimensional vessel localization","volume":"18","author":"Zhao M","year":"2000","unstructured":"Zhao M, Charbel FT, Alperin N, Loth F, Clark ME. Improved phase-contrast flow quantification by three-dimensional vessel localization. Magn Reson Imaging. 2000;18(6):697\u2013706."},{"issue":"3","key":"b22","series-title":"Neurosurgery","first-page":"332","article-title":"Donor selection in flow replacement bypass surgery for cerebral aneurysms: quantitative analysis of long-term native donor flow sufficiency","volume":"78","author":"Rustemi O","year":"2016","unstructured":"Rustemi O, Amin-Hanjani S, Shakur SF, Du X, Charbel FT. Donor selection in flow replacement bypass surgery for cerebral aneurysms: quantitative analysis of long-term native donor flow sufficiency. Neurosurgery. 2016;78(3):332\u2013342."},{"issue":"2","key":"b23","series-title":"J Neurosurg","first-page":"291","article-title":"Evaluation of extracranial-intracranial bypass using quantitative magnetic resonance angiography","volume":"106","author":"Amin-Hanjani S","year":"2007","unstructured":"Amin-Hanjani S, Shin JH, Zhao M, Du X, Charbel FT. Evaluation of extracranial-intracranial bypass using quantitative magnetic resonance angiography. J Neurosurg. 2007;106(2):291\u2013298."},{"issue":"1","key":"b24","series-title":"Neurosurgery","first-page":"111","article-title":"Hemodynamic changes after unilateral revascularization for moyamoya disease: serial assessment by quantitative magnetic resonance angiography","volume":"81","author":"Kim T","year":"2017","unstructured":"Kim T, Bang JS, Kwon OK,  Hemodynamic changes after unilateral revascularization for moyamoya disease: serial assessment by quantitative magnetic resonance angiography. Neurosurgery. 2017;81(1):111\u2013119."},{"issue":"3","key":"b25","series-title":"J Neurosurg","first-page":"677","article-title":"Quantitative assessment of changes in hemodynamics of the internal carotid artery after bypass surgery for moyamoya disease","volume":"129","author":"Zhu F","year":"2018","unstructured":"Zhu F, Qian Y, Xu B,  Quantitative assessment of changes in hemodynamics of the internal carotid artery after bypass surgery for moyamoya disease. J Neurosurg. 2018;129(3):677\u2013683."},{"issue":"6","key":"b26","series-title":"Neurosurgery","first-page":"962","article-title":"Combined direct and indirect bypass for moyamoya: quantitative assessment of direct bypass flow over time","volume":"73","author":"Amin-Hanjani S","year":"2013","unstructured":"Amin-Hanjani S, Singh A, Rifai H,  Combined direct and indirect bypass for moyamoya: quantitative assessment of direct bypass flow over time. Neurosurgery. 2013;73(6):962\u2013968."},{"issue":"5","key":"b27","series-title":"Oper Neurosurg (Hagerstown)","first-page":"337","article-title":"Intracranial\u2013intracranial bypass for aneurysms: quantitative intraoperative assessment of flow preservation","volume":"22","author":"Koch MJ","year":"2022","unstructured":"Koch MJ, Stapleton CJ, Charbel FT, Russin J, Amin-Hanjani S. Intracranial\u2013intracranial bypass for aneurysms: quantitative intraoperative assessment of flow preservation. Oper Neurosurg (Hagerstown). 2022;22(5):337\u2013342."},{"key":"b28","series-title":"Atlas of Neurosurgical Techniques","article-title":"Cerebral revascularization: Superficial temporal middle cerebral artery anastomosis","author":"Charbel FT","year":"2006","unstructured":"Charbel FT, Guppy KH, Ausman JI. Cerebral revascularization: Superficial temporal middle cerebral artery anastomosis. In: Sekhar LN, Fessler RG, eds. Atlas of Neurosurgical Techniques. Thieme;2006."},{"issue":"1","key":"b29","series-title":"J Neurosurg","first-page":"80","article-title":"Long-term patency in cerebral revascularization surgery: an analysis of a consecutive series of 430 bypasses","volume":"131","author":"Yoon S","year":"2018","unstructured":"Yoon S, Burkhardt JK, Lawton MT. Long-term patency in cerebral revascularization surgery: an analysis of a consecutive series of 430 bypasses. J Neurosurg. 2018;131(1):80\u201387."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/aop\/article-10.3171-2024.6.JNS2414\/article-10.3171-2024.6.JNS2414.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/aop\/article-10.3171-2024.6.JNS2414\/article-10.3171-2024.6.JNS2414.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/aop\/article-10.3171-2024.6.JNS2414\/article-10.3171-2024.6.JNS2414.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T01:30:25Z","timestamp":1740792625000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/aop\/article-10.3171-2024.6.JNS2414\/article-10.3171-2024.6.JNS2414.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,1]]},"references-count":29,"URL":"https:\/\/doi.org\/10.3171\/2024.6.jns2414","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,1]]}}}