{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:13:23Z","timestamp":1790417603797,"version":"4.1.0"},"reference-count":54,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There is dearth of literature on impact of age \u2013 pediatric versus adult, Suzuki staging \u2013 early versus late, and revascularization type \u2013 indirect versus direct on clinical and angiographic outcome in moyamoya disease (MMD). Hence, we intend to comprehensively evaluate factors influencing outcome in MMD following surgical revascularization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>MMD patients operated at our institute from January 2011 to August 2018 were followed for an average 24 months. Primary outcomes were modified Rankin score (mRS) and stroke risk reduction. Secondary outcome was angiographic outcome score (AOS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 133 patients including 37.6% adults (&gt;18 years;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 50) underwent 175 revascularizations \u2013 89 direct (DR) and 86 indirect (IR) subgroups. Mean mRS scores improved in pediatric DR (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), IR (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), adult IR (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.10), and DR (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.25) subgroups. Recurrent stroke rate was similar in pediatric-DR (2.7%) and IR (7.6%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.61), and adult-DR (0%) and IR (4.1%) subgroups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 1.00). AOS scores improved in pediatric DR (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002) and IR (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.01), and adult-DR (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.02) and IR (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.06) subgroups. Late-stage MMD (Suzuki IV\u2013VI) showed better improvement in mRS scores than early-stage-Suzuki (I\u2013III;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Recurrent stroke rates were similar (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.26) and AOS scores improved significantly in early- and late-stage MMD (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In pediatrics, clinical and angiographic outcome significantly improved after revascularization procedure, and in adults, angiographic improvement was more evident than clinical recovery. Late-stage Suzuki MMD patients demonstrated significantly better clinical improvement than early stage. The angiographic improvement was equivalent to early stage, irrespective of age and type of revascularization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/0028-3886.359200","type":"journal-article","created":{"date-parts":[[2022,11,1]],"date-time":"2022-11-01T03:31:06Z","timestamp":1667273466000},"page":"2072-2081","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Effect of Age, Stage, and Type of Surgical Revascularization on Clinical and Angiographic Outcome in Moyamoya Disease \u2013 Experience from a Case Series of 175 Revascularization Procedures"],"prefix":"10.4103","volume":"70","author":[{"given":"Sanjeev A","family":"Sreenivasan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Suri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amol","family":"Raheja","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhash","family":"Phuyal","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology and Neurointervention Imaging, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manmohan","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shashwat","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Tandon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leve J","family":"Devarajan1","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology and Neurointervention Imaging, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Kalaivani","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarat C","family":"Poodipedi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shashank S","family":"Kale","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,10,20]]},"reference":[{"key":"R1-20250926","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1161\/01.STR.11.6.656","article-title":"Progressive vascular changes in Moyamoya syndrome","volume":"11","author":"Murphy","year":"1980","journal-title":"Stroke"},{"key":"R2-20250926","doi-asserted-by":"crossref","first-page":"252","DOI":"10.4103\/1793-5482.162681","article-title":"Outcome of revascularization in moyamoya disease. 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