The Demise of EC-IC Bypass Surgery

Extracranial-intracranial bypass plus medical therapy for symptomatic carotid occlusion was no more effective than medical therapy alone at preventing stroke and early mortality in a randomized trial.

During the 1980s, a large trial showed that extracranial-to-intracranial (EC-IC) arterial bypass surgery was ineffective for stroke prevention. A lingering question was whether patients with objective evidence of hemispheric hypoperfusion would benefit from surgery. The Carotid Occlusion Surgery Study (COSS) was undertaken to study patients with symptomatic carotid occlusion and evidence on positron emission tomography of increased oxygen extraction ipsilateral to the occlusion, a marker of hemodynamic cerebral ischemia. Participants were randomized to optimal medical therapy with or without EC-IC surgery. The primary outcome was the composite of stroke or death within 30 days after either surgery or randomization, and ipsilateral stroke wi…

Reviewing Author

Seemant Chaturvedi, MD, FAHA, FAAN

Disclosures

Consultant/Advisory BoardBayer Pharmaceuticals; Novartis

Grant/Research SupportNational Institute of Neurological Disorders and Stroke

Editorial BoardsNeurology; Stroke

Seemant Chaturvedi, MD, FAHA, FAAN

Disclosures

Consultant/Advisory BoardBayer Pharmaceuticals; Novartis

Grant/Research SupportNational Institute of Neurological Disorders and Stroke

Editorial BoardsNeurology; Stroke

The Demise of EC-IC Bypass Surgery

Topics

Reviewing Author