Extracranial-Intracranial Bypass and Risk of Stroke and Death in Patients With Symptomatic Artery Occlusion

作者：Yan Ma, Tao Wang, Haibo Wang, Sepideh Amin‐Hanjani, Xiaoguang Tong, Jiyue Wang, Zhiyong Tong, Dong Kuai, Yiling Cai, Jun Ren, Donghai Wang, Lian Duan, Aisha Maimaitili, Chun‐Hua Hang, Jiasheng Yu, Xuesong Bai, William J. Powers, Colin P. Derdeyn, Yangfeng Wu, Feng Ling, Yuxiang Gu, Liqun Jiao, CMOSS Investigators, Liqun Jiao, Yuxiang Gu, Xiaoguang Tong, Jiyue Wang, Zhiyong Tong, Dong Kuai, Yiling Cai, Jun Ren, Donghai Wang, Lian Duan, Aisha Maimaitili, Chun‐Hua Hang, Jiasheng Yu, Feng Ling, Jie Lu, Qinjian Sun, Hongqi Zhang, Kun Yi Yang, Haiqing Song, Wenhuo Chen, Fajun Chen, Baofeng Xu, Shenmao Li, Bingjie Zheng, Jia Yu, Weiwu Hu, Jichang Luo, Yao Feng, Yan Ma, Tao Wang, Haibo Wang, Yangfeng Wu, Xiangchen Wu, Wei Ni, Chao Gao, Jiabin Su, Jiheng Hao, Liyong Sun, Gang Wang, Lizhi Bao, Xuan Xuan, Zhaolong Zhang, Bo Tang, Peng Zhao, Cong Han, Heguan Fu, Zhen Guo, Yi Wang, Rudong Chen, Miaomiao Zhu, Bairu Zhang, Tianchen Wu, Yang Wu, Meng Fan · 发表于：JAMA · 年份：2023 · DOI：10.1001/jama.2023.13390 · 被引用次数：99 · 研究领域：Cerebrovascular and Carotid Artery Diseases、Neurological Disease Mechanisms and Treatments、Moyamoya disease diagnosis and treatment

Importance: Prior trials of extracranial-intracranial (EC-IC) bypass surgery showed no benefit for stroke prevention in patients with atherosclerotic occlusion of the internal carotid artery (ICA) or middle cerebral artery (MCA), but there have been subsequent improvements in surgical techniques and patient selection. Objective: To evaluate EC-IC bypass surgery in symptomatic patients with atherosclerotic occlusion of the ICA or MCA, using refined patient and operator selection. Design, Setting, and Participants: This was a randomized, open-label, outcome assessor-blinded trial conducted at 13 centers in China. A total of 324 patients with ICA or MCA occlusion with transient ischemic attack or nondisabling ischemic stroke attributed to hemodynamic insufficiency based on computed tomography perfusion imaging were recruited between June 2013 and March 2018 (final follow-up: March 18, 2020). Interventions: EC-IC bypass surgery plus medical therapy (surgical group; n = 161) or medical therapy alone (medical group; n = 163). Medical therapy included antiplatelet therapy and stroke risk factor control. Main Outcomes and Measures: The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days through 2 years after randomization. There were 9 secondary outcomes, including any stroke or death within 2 years and fatal stroke within 2 years. Results: Among 330 patients who were enrolled, 324 patients were confirmed eligible (median ag...