Evidence map›Paper›PMID 40884244›Full record

ArticleEuropean stroke journal2025

Outcomes of bypass surgery in asymptomatic moyamoya angiopathy: A multicenter study with propensity-score weighting.

Basel Musmar, Hammam Abdalrazeq, Joanna M Roy, Nimer Adeeb, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan A Grossberg and 34 more

Abstract read
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In one paragraph

Article in European stroke journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

44 authors.

Basel MusmarDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Hammam AbdalrazeqDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Joanna M RoyDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Nimer AdeebDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Elias AtallahDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Kareem El NaamaniDepartment of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA.
Ching-Jen ChenDepartment of Neurosurgery, The University of Texas Health Science Center, Houston, TX, USA.ORCID 0000-0002-7830-9273
Roland JabreDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Hassan SaadDepartment of Neurosurgery, Emory University, Atlanta, GA, USA.
Jonathan A GrossbergDepartment of Neurosurgery, Emory University, Atlanta, GA, USA.
Adam A DmytriwDepartment of Medical Imaging, University of Toronto Faculty of Medicine, Toronto, ON, Canada.
Aman B PatelNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Mirhojjat KhorasanizadehDepartment of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Christopher S OgilvyDepartment of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Ajith J ThomasDepartment of Neurological Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA.
Andre MonteiroDepartment of Neurosurgery, University of New York at Buffalo, Buffalo, NY, Buffalo.
Adnan SiddiquiDepartment of Neurosurgery, University of New York at Buffalo, Buffalo, NY, Buffalo.
Gustavo M CortezLyerly Neurosurgery, Baptist Health System, Jacksonville, FL, USA.
Ricardo A HanelLyerly Neurosurgery, Baptist Health System, Jacksonville, FL, USA.
Guilherme PortoDepartment of Neurosurgery and Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA.
Alejandro M SpiottaDepartment of Neurosurgery and Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA.
Anthony J PiscopoDepartment of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA, USA.
David M HasanDepartment of Neurosurgery, Duke University, Durham, NC, USA.
Mohammad GhorbaniDepartment of Neurosurgery, Firoozgar Hospital, Tehran, Iran.
Joshua WeinbergDepartment of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Shahid M NimjeeDepartment of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Kimon BekelisGood Samaritan Hospital Medical Center, Babylon, NY, USA.
Mohamed M SalemDepartment of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA.
Jan-Karl BurkhardtDepartment of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA.
Akli ZetchiDepartment of Neurosurgery, Yale University, New Haven, CT, USA.
Charles MatoukDepartment of Neurosurgery, Yale University, New Haven, CT, USA.
Brian M HowardDepartment of Neurosurgery, Emory University, Atlanta, GA, USA.
Rosalind LaiDepartment of Neurosurgery, University of New York at Buffalo, Buffalo, NY, Buffalo.
Rose DuNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Rawad AbbasDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Abdelaziz AmllayDepartment of Neurosurgery, Yale University, New Haven, CT, USA.ORCID 0000-0003-3357-4134
Alfredo MunozDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Nabeel A HerialDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Stavropoula I TjoumakarisDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Michael Reid GoochDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Christina NotarianniDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Bharat GuthikondaDepartment of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Robert H RosenwasserDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Pascal JabbourDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.ORCID 0000-0002-8965-2413

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionAsymptomatic moyamoya angiopathy (MMA) is increasingly detected through noninvasive imaging; however, its optimal management remains controversial. This multicenter retrospective cohort study compared outcomes in asymptomatic versus symptomatic MMA patients undergoing surgical revascularization. PATIENTS AND

methodsA total of 475 patients treated with bypass surgery across multiple academic centers were included, with 56 (11.8%) classified as asymptomatic and 419 (88.2%) as symptomatic. Baseline demographics, surgical characteristics, and outcomes-including perioperative stroke, intraoperative complications, and follow-up stroke events-were collected. Asymptomatic MMA was defined as the absence of any prior ischemic or hemorrhagic stroke, seizures, or other neurological symptoms at the time of diagnosis. Both unadjusted analyses and propensity score weighting using inverse probability of treatment weighting (IPTW) were performed to adjust for potential confounders.

resultsIn the unadjusted analysis, asymptomatic patients had significantly lower rates of all perioperative strokes (1.7% vs 11.4%;

conclusionBypass surgery in selected asymptomatic MMA patients is associated with reduced intraoperative complications, and fewer follow-up stroke rates. These findings support the careful consideration of surgical intervention in asymptomatic patients, emphasizing the importance of patient selection for optimal outcomes.

Indexed as

asymptomaticbypassIPTWMMAstroke

Identifiers

PMID40884244
PMCPMC12398466

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