Surgery No Help In Preventing Strokes
Adding extracranial-intracranial bypass surgery to optimal medical therapy did not prevent strokes in patients with symptomatic atherosclerotic internal carotid artery occlusion and hemodynamic cerebral ischemia, researchers found.
In a trial stopped for futility, the addition of extracranial-intracranial bypass surgery improved brain perfusion but did not reduce the two-year rate of ipsilateral ischemic stroke (P=0.78), according to William Powers, MD, of the University of North Carolina at Chapel Hill, and colleagues.
There were no differences between the groups on any of the secondary endpoints either, the researchers reported in the Nov. 9 issue of the Journal of the American Medical Association.
The trial -- the Carotid Occlusion Surgery Study (COSS) -- "joins the list of stroke trials in which a successful outcome as measured by an important biologic marker of brain perfusion -- improved oxygen extraction ratio after the bypass procedure -- was not reflected in improved clinical outcome at two years," according to Joseph Broderick, MD, of the University of Cincinnati, and Philip Meyers, MD, of Columbia University in New York City.