Abstract Background To summarize the clinical and radiological outcomes of a novel cerebral revascularization technique based on the superficial temporal artery patency concept (STAPC) in patients with moyamoya disease (MMD). Methods A retrospective review was conducted of adult patients with MMD treated at Beijing Hospital and Nanjing Drum Tower Hospital between January 2019 and December 2021. The cohort comprised 170 patients who underwent superficial temporal artery–middle cerebral artery bypass with encephalo-duro-arterio-synangiosis (EDAS) (STA-MCA/EDAS), and 133 who underwent EDAS alone. Radiological follow-up included computed tomography (CT) angiography (CTA) to assess bypass patency and CT perfusion (CTP) for hemodynamic staging at 3 and 12 months post-revascularization. Clinical follow-up recorded perioperative complications and recurrent stroke events that occurred > 12 months postoperativerly. Results Of the 303 patients, 37 cases (12.21%) had perioperative complications including 27 cases (15.9%) in the STA-MCA/EDAS group and 10 cases (7.5%) in the EDAS group. Perfusion improvement was observed in 23.76% of patients (25.7% in the STA-MCA/EDAS group and 17.8% in the EDAS group) at 3 months postsurgical, and in 40.17% of patients (48.68% in the STA-MCA/EDAS group and 24.39% in the EDAS group) at 12 months postsurgical. Bypass patency was observed in 95.29% of patients (96.1% in the STA-MCA/EDAS group and 93.5% in the EDAS group) at 3 months postoperative, and in 96.43% patients (95.2% in the STA-MCA/EDAS group and 97.1% in the EDAS group) at 12 months postoperative. Of the 249 patients with a median follow-up period of 50 months (range 12–70 months), 40 cases (16.06%, 3.85% per year) had recurrent stroke events including 22 (15.41%, 3.69% per year) in the STA-MCA/EDAS group and 18 (16.67%, 3.91% per year) in the EDAS group. Conclusions Cerebral revascularization using STAPC is an acceptable surgical strategy for preventing stroke recurrence in patients with MMD.
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