ORIGINAL RESEARCH article
Front. Neurol.
Sec. Endovascular and Interventional Neurology
Preliminary Comparison of Efficacy and Safety Between Direct Bypass 1 Surgery and Endovascular Recanalization Therapy in Adult Ischemic 2 Moyamoya Disease
Provisionally accepted
- Second Hospital of Hebei Medical University, Shijiazhuang, China
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Objective: To compare the efficacy of endovascular recanalization therapy and 20 direct bypass surgery in treating adult ischemic moyamoya disease. 21 Methods: This retrospective study evaluated vascular wall conditions and 22 occlusion characteristics preoperatively using high-resolution magnetic resonance 23 imaging (HRMRI). Computed tomography angiography (CTA) and CT perfusion 24 (CTP) were performed preoperatively, at 7 days, and 3 months postoperatively to 25 assess vascular patency and cerebral perfusion. Modified Rankin Scale (mRS) scores 26 were used to evaluate neurological function at corresponding time points. 27 Results: A total of 67 adult patients with ischemic moyamoya disease were 28 included, comprising 43 patients undergoing direct bypass surgery (bypass group) and 29 2 24 receiving endovascular recanalization therapy (endovascular group). Intraoperative 30 indocyanine green angiography confirmed successful anastomosis or recanalization in 31 all patients. Postoperative imaging showed no cerebral hemorrhage or acute infarction. 32 Both groups demonstrated significant improvements in cerebral perfusion parameters 33 compared to baseline (P < 0.05). The majority of patients in both groups maintained a 34 favorable functional outcome (mRS≤2) postoperatively, and no significant differences 35 in mRS scores were found between groups at any time point (P > 0.05). 36 Complications were fewer and hospitalization duration was shorter in the 37 endovascular group, with lower incidence of hyperperfusion symptoms and 38 perioperative adverse events. 39 Conclusions: In this preliminary study, endovascular recanalization therapy was 40 feasible and demonstrated promising short-term outcomes, showing comparable 41 improvements in cerebral perfusion and neurological function to direct bypass surgery 42 at 3-month follow-up. However, the long-term durability, restenosis rates, and clinical 43 implications of this finding require further investigation.
Keywords: cerebral perfusion, Cerebral Revascularization, Endovascular Procedures, Ischemia, Moyamoya Disease
Received: 20 Aug 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Yang, Liu, Liang, Zhao, Dong, Zhang, Feng, Li and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yanan Li
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