机构：[1]Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China.神经科系统神经外科首都医科大学宣武医院[2]Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China[3]Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China[4]Department of Interventional Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China江苏省人民医院[5]Department of Neurosurgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University and Shanxi Cardiovascular Hospital, Taiyuan, China[6]Department of Neurosurgery, Huanhu Hospital, Tianjin, China[7]Department of Neurosurgery, Huashan Hospital, Fudan University, National Center for Neurological Disorders, Shanghai, China[8]Department of Neurosurgery, Liaocheng People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Liaocheng City, China[9]Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China[10]Department of Neurology, Strategic Support Force Medical Center, Beijing, China[11]Department of Neurosurgery, The Second Hospital of Lan Zhou University, China[12]Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China[13]Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China[14]Department of Neurosurgery, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China[15]Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China[16]Department of Neurosurgery, Nanjing Drum Tower Hospital, Neurosurgical Institute of Nanjing University, Nanjing University Medical School, China[17]Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China华中科技大学同济医学院附属同济医院[18]Department of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China.神经科系统医技科室神经外科放射科首都医科大学宣武医院
Previous trials have failed to demonstrate the benefits of extracranial-intracranial (EC-IC) bypass surgery for patients with carotid or middle cerebral artery occlusion. However, little evidence has focused on the effect of age on prognosis. This study aimed to explore whether EC-IC bypass surgery can provide greater benefits than medical therapy alone in specific age groups.A post hoc analysis was performed of the CMOSS (Carotid or Middle Cerebral Artery Occlusion Surgery Study), which was a randomized, open-label, outcome assessor-blinded trial conducted at 13 centers in China between June 2013 and March 2018. A total of 324 patients with internal carotid artery or middle cerebral artery occlusion with transient ischemic attack or nondisabling ischemic stroke attributed to hemodynamic insufficiency were randomized into a surgical group (n=161) that underwent EC-IC bypass surgery with medical therapy, and a medical group (n=163) that received antiplatelet therapy and stroke risk factor control alone. The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days up to 2 years after randomization. Receiver operating characteristic curves were drawn to explore the optimal age boundary, and survival analyses were used to explore differences between groups.Among the 324 patients (median age, 52.7 years; 79.3% men), an age cutoff of 55.5 years predicted the primary outcome in the surgical group (area under the curve, 0.649 [95% CI, 0.530-0.769]). Patients were further divided into an older group (>55.5 years) and a younger group (≤55.5 years). Younger patients who underwent bypass surgery showed a lower risk of the primary outcome (log-rank P=0.001) than older patients. Patients who underwent EC-IC bypass surgery had a lower risk than patients with medical therapy alone in the younger group (3.2% versus 11.6%; hazard ratio, 0.255 [95% CI, 0.071-0.916]; P=0.036), but not in the older group (17.5% versus 13.3%; adjusted hazard ratio, 0.597 [95% CI, 0.225-1.580]; P=0.298).In patients aged 55.5 years or younger with symptomatic atherosclerotic occlusion of the internal carotid artery or middle cerebral artery and hemodynamic insufficiency, the addition of EC-IC bypass surgery to medical therapy significantly improved prognosis. These findings suggest that the clinical application of EC-IC bypass surgery needs more research to explore refined patient selection criteria incorporating more clinical features.URL: https://www.clinicaltrials.gov; Unique identifier: NCT01758614.
基金：
The study was supported by grants from the Beijing Hospitals Authority’s Ascent Plan (DFL20220702), the Beijing Hospitals Authority Clinical Medicine
Development of Special Funding (ZLRK202320), the Beijing Nova Program
(20230484336), and the Xuanwu Hospital Talent Seed Program (YC20220120).
语种：
外文
PubmedID：
中科院(CAS)分区：
出版当年[2023]版：
大类|1 区医学
小类|1 区临床神经病学1 区外周血管病
最新[2023]版：
大类|1 区医学
小类|1 区临床神经病学1 区外周血管病
第一作者：
第一作者机构：[1]Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China.[2]Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
共同第一作者：
通讯作者：
通讯机构：[1]Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China.[2]Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China[18]Department of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China.[*1]Department of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital, China International Neuroscience Institute,Capital Medical University, National Center for Neurological Disorders, 45 Changchun St, Beijing 100053, China[*2]Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, 45 Changchun St, Beijing 100053, China[*3]Department of Neurosurgery, N China University of Science and Technology Affiliated Hospital, 73 Jianshe S Rd, Tangshan, Hebei 063000, China
推荐引用方式(GB/T 7714)：
Li Xin,Li Yaowei,Wang Tao,et al.Determining the Optimal Age for Extracranial-Intracranial Bypass Surgery: A Post Hoc Analysis of the CMOSS Randomized Trial[J].Stroke.2024,doi:10.1161/STROKEAHA.124.048766.
APA：
Li Xin,Li Yaowei,Wang Tao,Sun Xinyi,Lu Guangdong...&Jiao Liqun.(2024).Determining the Optimal Age for Extracranial-Intracranial Bypass Surgery: A Post Hoc Analysis of the CMOSS Randomized Trial.Stroke,,
MLA：
Li Xin,et al."Determining the Optimal Age for Extracranial-Intracranial Bypass Surgery: A Post Hoc Analysis of the CMOSS Randomized Trial".Stroke .(2024)
医学