{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T11:42:12Z","timestamp":1781091732149,"version":"3.54.1"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"23","license":[{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,12,2]]},"abstract":"\n BACKGROUND<\/jats:title>\n Moyamoya disease (MMD) is a cerebrovascular disorder that is characterized by progressive stenosis in the terminal portions of the internal carotid artery (ICA). Although a substantial number of patients with MMD exhibit stenosis of the ICA orifice (ICAO), it infrequently occurs in patients with MMD with external carotid artery orifice (ECAO) stenosis.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 48-year-old female with no past medical history presented to the authors\u2019 hospital with right hemiparesis and motor aphasia. Head magnetic resonance imaging revealed bilateral acute cerebral infarctions in the left frontal lobe, and magnetic resonance angiography demonstrated bilateral ICA terminal stenosis. Digital subtraction angiography revealed severe stenosis in the right ICAO and left ICAO and ECAO, as well as bilateral ICA terminal stenosis; therefore, the authors diagnosed this case as MMD. They first performed percutaneous transluminal angioplasty (PTA) using the kissing balloon technique (KBT) for the stenosis in the left ICAO and ECAO, followed by PTA for the right ICAO stenosis. After that, they performed bilateral direct and indirect revascularization.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n The authors present a rare case of MMD with stenosis of the ICAO and ECAO, which was treated with PTA using the KBT, followed by direct and indirect revascularization. Although the strategy is controversial in terms of which treatment should be performed first, this method of anterograde revascularization was a promising strategy.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24425<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24425","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T01:51:48Z","timestamp":1733104308000},"source":"Crossref","is-referenced-by-count":2,"title":["Kissing balloon treatment for stenosis of the internal and external carotid artery orifice associated with moyamoya disease: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Takayuki","family":"Morimoto","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Nara City Hospital, Nara, Nara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenta","family":"Fujimoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nara Prefecture General Medical Center, Nara, Nara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Chul","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nara City Hospital, Nara, Nara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshikazu","family":"Nishioka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nara City Hospital, Nara, Nara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidemori","family":"Tokunaga","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nara City Hospital, Nara, Nara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12","key":"bib1","series-title":"N Engl J Med","first-page":"1226","article-title":"Moyamoya disease and moyamoya syndrome","volume":"360","author":"Scott","year":"2009","unstructured":"Scott RMSmith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med. 2009;360(12):1226-1237."},{"issue":"11","key":"bib2","series-title":"Lancet Neurol","first-page":"1056","article-title":"Moyamoya disease: current concepts and future perspectives","volume":"7","author":"Kuroda","year":"2008","unstructured":"Kuroda SHoukin K. Moyamoya disease: current concepts and future perspectives. Lancet Neurol. 2008;7(11):1056-1066."},{"issue":"1","key":"bib3","series-title":"J Magn Reson Imaging","first-page":"94","article-title":"The characteristics of extracranial internal carotid artery and their relationship with surgical outcomes in patients with moyamoya disease: a combined head-and-neck vessel wall MR imaging study","volume":"60","author":"Lu","year":"2024","unstructured":"Lu MLiu SPeng P, et al. The characteristics of extracranial internal carotid artery and their relationship with surgical outcomes in patients with moyamoya disease: a combined head-and-neck vessel wall MR imaging study. J Magn Reson Imaging. 2024;60(1):94-102."},{"issue":"2","key":"bib4","series-title":"J Neurol","first-page":"997","article-title":"The angiographic presentation of European moyamoya angiopathy","volume":"269","author":"Pilgram-Pastor","year":"2022","unstructured":"Pilgram-Pastor SChapot RKraemer M. The angiographic presentation of European moyamoya angiopathy. J Neurol. 2022;269(2):997-1006."},{"issue":"1","key":"bib5","series-title":"Neuroradiology","first-page":"29","article-title":"Proximal internal carotid artery stenosis associates with diffuse wall thickening in petrous arterial segment of moyamoya disease patients: a three-dimensional magnetic resonance vessel wall imaging study","volume":"61","author":"Chen","year":"2019","unstructured":"Chen XWang JLiu Y, et al. Proximal internal carotid artery stenosis associates with diffuse wall thickening in petrous arterial segment of moyamoya disease patients: a three-dimensional magnetic resonance vessel wall imaging study. Neuroradiology. 2019;61(1):29-36."},{"issue":"12","key":"bib6","series-title":"J Ultrasound Med","first-page":"1547","article-title":"Bottle neck sign of the proximal portion of the internal carotid artery in moyamoya disease","volume":"25","author":"Yasaka","year":"2006","unstructured":"Yasaka MOgata TYasumori KInoue TOkada Y. Bottle neck sign of the proximal portion of the internal carotid artery in moyamoya disease. J Ultrasound Med. 2006;25(12):1547-1554."},{"issue":"8","key":"bib7","series-title":"Neurol Med Chir (Tokyo)","first-page":"356","article-title":"Stenosis of the proximal external carotid artery in an adult with moyamoya disease: moyamoya or atherosclerotic change?","volume":"47","author":"Lee","year":"2007","unstructured":"Lee SJAhn JY. Stenosis of the proximal external carotid artery in an adult with moyamoya disease: moyamoya or atherosclerotic change? Neurol Med Chir (Tokyo). 2007;47(8):356-359."},{"issue":"3","key":"bib8","series-title":"Acta Neurochir (Wien)","first-page":"323","article-title":"Extracranial vertebral artery stenosis in a patient with moyamoya disease","volume":"141","author":"H\u00e4ckel","year":"1999","unstructured":"H\u00e4ckel MNeumann JBene\u0161 V Jr. Extracranial vertebral artery stenosis in a patient with moyamoya disease. Acta Neurochir (Wien). 1999;141(3):323-324."},{"issue":"19","key":"bib9","series-title":"J Am Heart Assoc","first-page":"e016670","article-title":"Prospective screening of extracranial systemic arteriopathy in young adults with moyamoya disease","volume":"9","author":"Jee","year":"2020","unstructured":"Jee TKYeon JYKim SMBang OYKim JSHong SC. Prospective screening of extracranial systemic arteriopathy in young adults with moyamoya disease. J Am Heart Assoc. 2020;9(19):e016670."},{"key":"bib10","series-title":"World Neurosurg","first-page":"76","article-title":"Carotid artery stenting for symptomatic internal carotid artery stenosis associated with moyamoya disease","volume":"123","author":"Maki","year":"2019","unstructured":"Maki YHattori ESatow TKomuro TMiyamoto S. Carotid artery stenting for symptomatic internal carotid artery stenosis associated with moyamoya disease. World Neurosurg. 2019;123:76-80."},{"issue":"6","key":"bib11","series-title":"Minerva Cardioangiol","first-page":"643","article-title":"Extracranial internal carotid artery stenting in Moya-Moya syndrome: a case report","volume":"60","author":"Casana","year":"2012","unstructured":"Casana RTolva VGuy Bianchi PDalainas I. Extracranial internal carotid artery stenting in Moya-Moya syndrome: a case report. Minerva Cardioangiol. 2012;60(6):643-646."},{"key":"bib12","series-title":"Ann Vasc Surg","first-page":"269.e9","article-title":"Carotid endarterectomy in moyamoya disease: a case report","volume":"34","author":"Spentzouris","year":"2016","unstructured":"Spentzouris GMulvihill ZHines G. Carotid endarterectomy in moyamoya disease: a case report. Ann Vasc Surg. 2016;34:269.e9-269.e11."},{"issue":"9","key":"bib13","series-title":"JACC Cardiovasc Interv","first-page":"923","article-title":"Impact of kissing balloon inflation on the main vessel stent volume, area, and symmetry after side-branch dilation in patients with coronary bifurcation lesions","volume":"6","author":"Rahman","year":"2013","unstructured":"Rahman SLeesar TCilingiroglu M, et al. Impact of kissing balloon inflation on the main vessel stent volume, area, and symmetry after side-branch dilation in patients with coronary bifurcation lesions. JACC Cardiovasc Interv. 2013;6(9):923-931."},{"issue":"4","key":"bib14","series-title":"Minim Invasive Neurosurg","first-page":"214","article-title":"Percutaneous transluminal angioplasty using kissing balloon technique for carotid bifurcation stenoses coupled with the proatlantal intersegmental artery: a case report","volume":"41","author":"Mori","year":"1998","unstructured":"Mori TFukuoka MKazita KMori K. Percutaneous transluminal angioplasty using kissing balloon technique for carotid bifurcation stenoses coupled with the proatlantal intersegmental artery: a case report. Minim Invasive Neurosurg. 1998;41(4):214-216."},{"issue":"12","key":"bib1","series-title":"N Engl J Med","first-page":"1226","article-title":"Moyamoya disease and moyamoya syndrome","volume":"360","author":"Scott","year":"2009","unstructured":"Scott RMSmith ER. Moyamoya disease and moyamoya syndrome. 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J Am Heart Assoc. 2020;9(19):e016670."},{"key":"bib10","series-title":"World Neurosurg","first-page":"76","article-title":"Carotid artery stenting for symptomatic internal carotid artery stenosis associated with moyamoya disease","volume":"123","author":"Maki","year":"2019","unstructured":"Maki YHattori ESatow TKomuro TMiyamoto S. Carotid artery stenting for symptomatic internal carotid artery stenosis associated with moyamoya disease. World Neurosurg. 2019;123:76-80."},{"issue":"6","key":"bib11","series-title":"Minerva Cardioangiol","first-page":"643","article-title":"Extracranial internal carotid artery stenting in Moya-Moya syndrome: a case report","volume":"60","author":"Casana","year":"2012","unstructured":"Casana RTolva VGuy Bianchi PDalainas I. Extracranial internal carotid artery stenting in Moya-Moya syndrome: a case report. Minerva Cardioangiol. 2012;60(6):643-646."},{"key":"bib12","series-title":"Ann Vasc Surg","first-page":"269.e9","article-title":"Carotid endarterectomy in moyamoya disease: a case report","volume":"34","author":"Spentzouris","year":"2016","unstructured":"Spentzouris GMulvihill ZHines G. Carotid endarterectomy in moyamoya disease: a case report. Ann Vasc Surg. 2016;34:269.e9-269.e11."},{"issue":"9","key":"bib13","series-title":"JACC Cardiovasc Interv","first-page":"923","article-title":"Impact of kissing balloon inflation on the main vessel stent volume, area, and symmetry after side-branch dilation in patients with coronary bifurcation lesions","volume":"6","author":"Rahman","year":"2013","unstructured":"Rahman SLeesar TCilingiroglu M, et al. Impact of kissing balloon inflation on the main vessel stent volume, area, and symmetry after side-branch dilation in patients with coronary bifurcation lesions. JACC Cardiovasc Interv. 2013;6(9):923-931."},{"issue":"4","key":"bib14","series-title":"Minim Invasive Neurosurg","first-page":"214","article-title":"Percutaneous transluminal angioplasty using kissing balloon technique for carotid bifurcation stenoses coupled with the proatlantal intersegmental artery: a case report","volume":"41","author":"Mori","year":"1998","unstructured":"Mori TFukuoka MKazita KMori K. Percutaneous transluminal angioplasty using kissing balloon technique for carotid bifurcation stenoses coupled with the proatlantal intersegmental artery: a case report. 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