We joined ISC2018 in Los Angeles between January 23 and 25, 2018. Prof. Kuroda presented our recent results of repeat bypass for moyamoya disease refractory to previous surgery. Dr. Uchino presented novel knowledge on circulating miRNA of moyamoya disease, which is his thesis for PhD at Hokkaido University. We could really enjoyed a dinner with my younger colleagues, including Dr. Masaki Ito from Stanford University.