Bypass Surgery for Stroke Prevention
Powers WJ, Clarke WR, Grubb RL Jr, Videen TO, Adams HP Jr, Derdeyn CP; COSS Investigators
JAMA. 2011;306:1983-1992
Does extracranial-intracranial bypass surgery reduce the risk for stroke in high-risk patients? The authors conducted a randomized multicenter trial in patients with internal carotid artery occlusion. The results, based on 97 surgical patients and 98 control patients who were treated medically, found no benefit with bypass surgery after 2 years. At 2 years, 21% of the surgical group and 23% of the nonsurgical group had an ipsilateral stroke (P = .78). The trial was discontinued because of the absence of any beneficial effect.
The results of this trial must have been very disappointing to both the trialists and participants. Despite excellent graft patency rates that were greater than 95%, bringing a new blood supply to the cerebral circulation did not prevent ipsilateral stroke. The findings contrast with those for coronary artery disease, in which bypass surgery is beneficial. This trial presents convincing evidence that extracranial-intracranial bypass surgery does not improve prognosis for patients with an internal arterial occlusion.
Abstract
Extracranial-Intracranial Bypass Surgery for Stroke Prevention in Hemodynamic Cerebral Ischemia: The Carotid Occlusion Surgery Study Randomized Trial
Powers WJ, Clarke WR, Grubb RL Jr, Videen TO, Adams HP Jr, Derdeyn CP; COSS Investigators
JAMA. 2011;306:1983-1992
Summary
Does extracranial-intracranial bypass surgery reduce the risk for stroke in high-risk patients? The authors conducted a randomized multicenter trial in patients with internal carotid artery occlusion. The results, based on 97 surgical patients and 98 control patients who were treated medically, found no benefit with bypass surgery after 2 years. At 2 years, 21% of the surgical group and 23% of the nonsurgical group had an ipsilateral stroke (P = .78). The trial was discontinued because of the absence of any beneficial effect.
Viewpoint
The results of this trial must have been very disappointing to both the trialists and participants. Despite excellent graft patency rates that were greater than 95%, bringing a new blood supply to the cerebral circulation did not prevent ipsilateral stroke. The findings contrast with those for coronary artery disease, in which bypass surgery is beneficial. This trial presents convincing evidence that extracranial-intracranial bypass surgery does not improve prognosis for patients with an internal arterial occlusion.
Abstract