Severe artery narrowing linked to stroke risk after moyamoya surgery

A Chinese study in the Chinese Neurosurgical Journal found that preoperative severe stenosis of major intracranial arteries raises the risk of cerebral infarction after revascularization surgery in adult patients with ischemic moyamoya disease. The findings could help doctors better predict postoperative stroke and target patients at higher risk.

Why it matters: - Moyamoya disease is treated with revascularization surgery to restore blood flow to the brain. - Post-surgical cerebral infarction remains a known complication, but reliable prediction tools have been limited. - Identifying high-risk patients could help surgeons adjust monitoring and mitigation strategies before and after surgery.

What happened: - Chinese researchers studied 119 patients with ischemic moyamoya disease who underwent combined revascularization surgery at Beijing Tiantan Hospital, Capital Medical University. - The study was published in the Chinese Neurosurgical Journal on 14 April 2026. - The team found that preoperative severe stenosis of the major intracranial arteries was associated with postoperative cerebral infarction. - New infarctions occurred in 11 hemispheres in 8 patients, or 5.5% of the cohort. - Three patients developed infarctions on both sides of the brain.

The details: - The research team was led by Dr. Yuanli Zhao and Prof. Rong Wang. - All patients had digital subtraction angiography, MRI and CT perfusion before surgery. - Patients also received CT imaging 4 to 6 hours after surgery and head MRI on days 5 to 7 after surgery. - The study used the Suzuki staging system to quantify cerebral artery blockage. - Infarction was identified by low-density signals on CT or prominent signals on MRI. - Severe blockage of the anterior, middle and posterior cerebral arteries was linked to postoperative infarction. - Three patients who developed postoperative cerebral ischemia underwent DSA after surgery. - Those patients had shown severe occlusion of the major arteries on preoperative imaging. - The full paper is titled Severe stenosis of major intracranial arteries: an important risk factor for infarction complications after combined revascularization in adult patients with ischemic moyamoya disease.

Between the lines: - The study strengthens the case for using preoperative vascular imaging to stratify surgical risk in adult moyamoya patients. - The result is clinically useful because postoperative ischemia is uncommon but serious, and even a small absolute risk affects treatment planning. - The findings are based on a single-center sample, so other factors may still influence outcomes. - The authors noted that age and surgery side could not be ruled out as confounders.

What's next: - The researchers say larger studies are needed to test additional risk factors and confirm the finding. - Future work could support new prediction protocols and management strategies for patients undergoing revascularization surgery. - Doctors may be able to use the finding to better identify patients who need closer postoperative surveillance.