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<p>Moyamoya angiopathy (MMA) lacks stage-specific comparative evidence for surgical strategy. Because many studies mix Suzuki grades, potential technique effects may be obscured. We compared direct revascularization (DR) with indirect revascularization (IR) in a stage-restricted cohort (Suzuki I-III), using propensity score weighting (PSW). We conducted a multicenter retrospective cohort study across 13 academic centers. Adults with confirmed MMA (Suzuki I-III) who underwent DR or IR were included. Patients &lt; 16 years and combined procedures were excluded. Outcomes were symptomatic stroke, overall perioperative stroke, intraoperative complications, discharge NIHSS/mRS, length of stay, and follow-up stroke. PSW used Covariate Balancing Propensity Scores (CBPS) with absolute standardized mean difference (ASMD) diagnostics. Group differences were modeled with logistic/linear regression, and stroke-free survival was compared by Kaplan-Meier/log-rank. We analyzed 208 hemispheres (IR = 104; DR = 104). Baseline demographics and comorbidities were similar. Unadjusted analyses showed no significant differences in overall perioperative stroke (10.5% IR vs. 8.6% DR; p=.63), symptomatic perioperative stroke, intraoperative complications, discharge NIHSS/mRS, length of stay, or follow-up stroke (8.6% IR vs. 5.8% DR; p=.43). Stroke-free survival did not differ (log-rank p=.40). After PSW, findings remained unchanged across endpoints (e.g., all perioperative stroke OR 1.82; 95% CI, 0.61 to 5.45; p=.27). In adults with MMA at Suzuki I-III, no significant between-group differences were detected between DR and IR in the studied clinical outcomes. Technique selection can be individualized to anatomy, hemodynamics, and center expertise. Prospective, stage-stratified studies with standardized angiographic and hemodynamic endpoints are warranted.</p>

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Direct Versus Indirect Bypass in Early-Stage Moyamoya (Suzuki I-III): A Propensity Score-Weighted Study

  • 期刊论文

  • 发表日期：

    2026年5月15日

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  • Basel Musmar,
  • Joanna M. Roy,
  • Hammam Abdalrazeq,
  • Victor Gabriel El-Hajj,
  • Michael Rizzuto,
  • Matthews Lan,
  • Pious Patel,
  • Michael Baldassari,
  • Arbaz Momin,
  • Yazan Shamli Oghli,
  • Marissa Tucci,
  • Joseph Schaefer,
  • Caitlin Ritz,
  • Keenan Piper,
  • Marc Mounzer,
  • Kareem El Naamani,
  • Ching-Jen Chen,
  • Roland Jabre,
  • Hassan Saad,
  • Jonathan A. Grossberg,
  • Adam A. Dmytriw,
  • Aman B. Patel,
  • Mirhojjat Khorasanizadeh,
  • Christopher S Ogilvy,
  • Ajith J. Thomas,
  • Andre Monteiro,
  • Adnan Siddiqui,
  • Gustavo M. Cortez,
  • Ricardo A. Hanel,
  • Guilherme Porto,
  • Alejandro M. Spiotta,
  • Anthony J. Piscopo,
  • David M. Hasan,
  • Mohammad Ghorbani,
  • Joshua Weinberg,
  • Shahid M. Nimjee,
  • Kimon Bekelis,
  • Mohamed M. Salem,
  • Jan-Karl Burkhardt,
  • Akli Zetchi,
  • Charles Matouk,
  • Brian M. Howard,
  • Rosalind Lai,
  • Rose Du,
  • Stavropoula I. Tjoumakaris,
  • Michael Reid Gooch,
  • Robert H. Rosenwasser,
  • Pascal Jabbour

摘要

Moyamoya angiopathy (MMA) lacks stage-specific comparative evidence for surgical strategy. Because many studies mix Suzuki grades, potential technique effects may be obscured. We compared direct revascularization (DR) with indirect revascularization (IR) in a stage-restricted cohort (Suzuki I-III), using propensity score weighting (PSW). We conducted a multicenter retrospective cohort study across 13 academic centers. Adults with confirmed MMA (Suzuki I-III) who underwent DR or IR were included. Patients < 16 years and combined procedures were excluded. Outcomes were symptomatic stroke, overall perioperative stroke, intraoperative complications, discharge NIHSS/mRS, length of stay, and follow-up stroke. PSW used Covariate Balancing Propensity Scores (CBPS) with absolute standardized mean difference (ASMD) diagnostics. Group differences were modeled with logistic/linear regression, and stroke-free survival was compared by Kaplan-Meier/log-rank. We analyzed 208 hemispheres (IR = 104; DR = 104). Baseline demographics and comorbidities were similar. Unadjusted analyses showed no significant differences in overall perioperative stroke (10.5% IR vs. 8.6% DR; p=.63), symptomatic perioperative stroke, intraoperative complications, discharge NIHSS/mRS, length of stay, or follow-up stroke (8.6% IR vs. 5.8% DR; p=.43). Stroke-free survival did not differ (log-rank p=.40). After PSW, findings remained unchanged across endpoints (e.g., all perioperative stroke OR 1.82; 95% CI, 0.61 to 5.45; p=.27). In adults with MMA at Suzuki I-III, no significant between-group differences were detected between DR and IR in the studied clinical outcomes. Technique selection can be individualized to anatomy, hemodynamics, and center expertise. Prospective, stage-stratified studies with standardized angiographic and hemodynamic endpoints are warranted.