Outcomes of Bypass Surgery in Asymptomatic Moyamoya Angiopathy: A Multicenter Study With Propensity-Score Weighting
Document Type
Article
Publication Date
1-1-2026
Abstract
INTRODUCTION: Asymptomatic 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 METHODS: A 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.
RESULTS: In the unadjusted analysis, asymptomatic patients had significantly lower rates of all perioperative strokes (1.7% vs 11.4%; p = 0.05) and intraoperative complications (1.7% vs 11.2%; p = 0.05) compared to symptomatic patients. Additionally, follow-up stroke rates were lower in the asymptomatic group (1.7% vs 11.2%; p = 0.05). After IPTW adjustment, the reduction in intraoperative complications (OR: 0.08, 95% CI: 0.01-0.64; p = 0.01) and follow-up stroke rates (OR: 0.12, 95% CI: 0.01-0.91; p = 0.04) persisted, while differences in overall perioperative stroke were not statistically significant.
CONCLUSION: Bypass 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.
Recommended Citation
Musmar, Basel; Abdalrazeq, Hammam; Roy, Joanna M.; Adeeb, Nimer; Atallah, Elias; El Naamani, Kareem; Chen, Ching-Jen; Jabre, Roland; Saad, Hassan; Grossberg, Jonathan A.; Dmytriw, Adam A.; Patel, Aman B.; Khorasanizadeh, Mirhojjat; Ogilvy, Christopher S.; Monteiro, Andre; Siddiqui, Adnan; Cortez, Gustavo M.; Hanel, Ricardo A.; Spiotta, Alejandro M.; Piscopo, Anthony J.; Hasan, David M.; Ghorbani, Mohammad; Weinberg, Joshua; Nimjee, Shahid M.; Salem, Mohamed M.; Burkhardt, Jan-Karl; Zetchi, Akli; Matouk, Charles; Howard, Brian M.; Lai, Rosalind; Du, Rose; Abbas, Rawad; Amllay, Abdelaziz; Munoz, Alfredo; Herial, Nabeel A.; Tjoumakaris, Stavropoula I.; Gooch, Michael R.; Notarianni, Christina; Guthikonda, Bharat; Rosenwasswer, Robert H.; and Jabbour, Pascal, "Outcomes of Bypass Surgery in Asymptomatic Moyamoya Angiopathy: A Multicenter Study With Propensity-Score Weighting" (2026). Department of Neurosurgery Faculty Papers. Paper 289.
https://jdc.jefferson.edu/neurosurgeryfp/289
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
41614506
Language
English
Comments
This article is the author’s final published version in European stroke journal, Volume 11, Issue 1, January 2026.
The published version is available at doi.org/10.1093/esj/23969873251365504. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Stroke Organisation 2026.