Evidence map›Paper›PMID 42138779›Full record

ArticleTranslational stroke research2026

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

Basel Musmar, Joanna M Roy, Hammam Abdalrazeq, Victor Gabriel El-Hajj, Michael Rizzuto, Matthews Lan, Pious Patel, Michael Baldassari, Arbaz Momin, Yazan Shamli Oghli and 38 more

Abstract readMulticenter StudyComparative Study
PubMed Publisher
In one paragraph

Article in Translational stroke research, 2026. 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

48 authors.

Basel MusmarDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Joanna M RoyDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Hammam AbdalrazeqDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Victor Gabriel El-HajjDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Michael RizzutoDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Matthews LanDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Pious PatelDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Michael BaldassariDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Arbaz MominDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Yazan Shamli OghliDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Marissa TucciDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Joseph SchaeferDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Caitlin RitzDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Keenan PiperDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Marc MounzerDepartment 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, CHI Health Creighton University Medical Center, Bergan Mercy, USA.
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, Harvard Medical School, Boston, MA, USA.
Christopher S OgilvyDepartment of Neurosurgery, Beth Israel Deaconess Medical Center, 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, USA.
Adnan SiddiquiDepartment of Neurosurgery, University of New York at Buffalo, Buffalo, NY, USA.
Gustavo M CortezLyerly Neurosurgery, Baptist Health System, Jacksonville, Jacksonville, FL, USA.
Ricardo A HanelLyerly Neurosurgery, Baptist Health System, Jacksonville, Jacksonville, FL, USA.
Guilherme PortoDepartment of Neurosurgery and Neuroendovascular Surgery, Medical University of South Carolina, SC, Charleston, USA.
Alejandro M SpiottaDepartment of Neurosurgery and Neuroendovascular Surgery, Medical University of South Carolina, SC, Charleston, 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, USA.
Rose DuNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 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.
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. pascal.jabbour@jefferson.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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.

Indexed as

Cerebral RevascularizationMoyamoya DiseaseAdultFemaleHumansMaleMiddle AgedPropensity ScoreRetrospective StudiesStrokeTreatment OutcomeBypassDirectIndirectMoyamoyaSuzuki

Identifiers

PMID42138779

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.