Objective To investigate the efficacy of cerebral revascularization （different surgical procedures） for stroke prevention and prognosis in ischemic-type moyamoya disease （MMD） through a multicenter retrospective study.Methods Clinical， neuroradiologic， and follow-up data of 462 patients with ischemic-type MMD from Xiangya Hospital of Central South University， Changde People’s Hospital， and Hunan Children’s Hospital were analyzed in this study. Propensity score matching was performed， and then the Kaplan-Meier curve was used to compare the recurrence rate of stroke between the patients receiving surgical treatment and those receiving conservative treatment. A multivariable Cox regression analysis was performed to identify the risk factors for stroke recurrence after surgical treatment.Results The mean follow-up time was 33.6 months in the 462 patients. Stroke occurred in 31 （12.8%） of the 242 surgically treated patients and 63 （28.6%） of the 220 conservatively treated patients. A total of 185 pairs were selected through propensity score matching. The Kaplan-Meier curve showed a significant difference in the incidence of recurrent stroke between the two groups （P=0.018）. The multivariable Cox regression analysis revealed that posterior cerebral artery involvement （95% confidence interval ［CI］： 2.343-11.375， P<0.001） and cerebral white matter hyperintensities （95% CI： 1.083-4.828， P=0.030） were risk factors for stroke recurrence after surgery. There was no significant difference between the two surgical procedures （combined and indirect revascularization） in the prevention of recurrent stroke （P=0.777）.Conclusions Compared with conservative treatment， surgical revascularization can reduce the incidence of recurrent stroke and achieve favorable outcome in ischemic-type MMD， and different surgical procedures are similar in preventing recurrent stroke.