Preliminary comparison of efficacy and safety between direct bypass surgery and endovascular recanalization therapy in adult ischemic moyamoya disease.

Objective: To compare the efficacy of endovascular recanalization therapy and direct bypass surgery in treating adult ischemic moyamoya disease. Methods: This retrospective study evaluated vascular wall conditions and occlusion characteristics preoperatively using high-resolution magnetic resonance imaging (HRMRI). Computed tomography angiography (CTA) and CT perfusion (CTP) were performed preoperatively, at 7 days, and 3 months postoperatively to assess vascular patency and cerebral perfusion. Modified Rankin Scale (mRS) scores were used to evaluate neurological function at corresponding time points. Results: A total of 67 adult patients with ischemic moyamoya disease were included, comprising 43 patients undergoing direct bypass surgery (bypass group) and 24 receiving endovascular recanalization therapy (endovascular group). Intraoperative indocyanine green angiography confirmed successful anastomosis or recanalization in all patients. Postoperative imaging showed no cerebral hemorrhage or acute infarction. Both groups demonstrated significant improvements in cerebral perfusion parameters compared to baseline ( Conclusion: In this preliminary study, endovascular recanalization therapy was feasible and demonstrated promising short-term outcomes, showing comparable improvements in cerebral perfusion and neurological function to direct bypass surgery at 3-month follow-up. However, the long-term durability, restenosis rates, and clinical implications of this finding require further investigation.