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, Huashan Hospital, Fudan University, National Center for Neurological Disorders, Shanghai, China.[3]Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China.[4]Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Tianjin, China.[5]Department of Neurosurgery, Huanhu Hospital, Tianjin, China.[6]Department of Neurosurgery, Liaocheng People's Hospital, Shandong First Medical University, Liaocheng, China.[7]Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.[8]Department of Neurosurgery, The First Hospital of China Medical University, Liaoning, China.[9]Department of Neurosurgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University and Shanxi Cardiovascular Hospital (Institute), Taiyuan, China.[10]Department of Neurology, The Ninth Medical Center, Chinese PLA General Hospital, Beijing, China.[11]Department of Neurosurgery, The Second Hospital of Lan Zhou University, Lanzhou, China.[12]Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China.[13]Department of Neurosurgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.[14]Department of Neurosurgery, The First Affiliated Hospital of XinJiang Medical University, Urumqi, China.[15]Department of Neurosurgery, Nanjing Drum Tower Hospital, Neurosurgical Institute of Nanjing University, Nanjing University Medical School, Nanjing, China.[16]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[17]Department of Interventional Neuroradiology, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China.医技科室放射科首都医科大学宣武医院[18]Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville.
Previous trials have shown no significant benefit of extracranialintracranial (EC-IC) bypass surgery vsmedical therapy in symptomatic patients with hemodynamically compromised internal carotid artery or middle carotid artery occlusion.1-3
CMOSS (Carotid and Middle
Cerebral Artery Occlusion
Surgery Study) was a multicenter, randomized clinical trial that compared EC-IC bypass
surgery plus medical treatment vs medical treatment alone.1,4
The primary outcome was neutral at the 2-year follow up1
; the
present report includes the longer-term follow-up results.
Methods | After finishing the initial preplanned follow-up, the
study protocol was amended and approved for long-term
follow-up of up to 10 years by institutional research ethics board
at each center (Supplement 1). An addendum consent was required. Among 330 patients initially randomized, 324 patients were eligible and followed up through June 12, 2024. The
primary outcome was a composite of any stroke or death within
30 days or ischemic stroke ipsilateral to the occluded artery
beyond 30 days after randomization. Analyses were conducted in all eligible randomized participants and also in a perprotocol set; secondary outcomes and sensitivity analyses to
address missing data were performed (eMethods in Supplement 2). The difference in the primary outcome was tested
using a log-rank test, with the center as a stratification factor.
P < .05 was considered statistically significant. χ2 or Fisher exact tests were used for categorical variables,ttests orWilcoxon
rank tests were used for continuous variables, and KaplanMeier analysis was used for the risk of time-to-event outcomes. All statistical tests were 2-sided and completed using SAS, version 9.4 (SAS Institute).
基金：
(2011BAI08B04) from the National Health Commission of the People’s Republic
of China and ZLRK202320 from Beijing Hospitals Authority Clinical Medicine
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.
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.[17]Department of Interventional Neuroradiology, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China.
推荐引用方式(GB/T 7714)：
Ma Yan,Wang Tao,Ni Wei,et al.Long-Term Follow-Up of Extracranial-Intracranial Bypass Surgery for Symptomatic Cerebral Artery Occlusion[J].JAMA.2025,doi:10.1001/jama.2025.7225.
APA：
Ma Yan,Wang Tao,Ni Wei,Wang Haibo,Liu Delin...&Jiao Liqun.(2025).Long-Term Follow-Up of Extracranial-Intracranial Bypass Surgery for Symptomatic Cerebral Artery Occlusion.JAMA,,
MLA：
Ma Yan,et al."Long-Term Follow-Up of Extracranial-Intracranial Bypass Surgery for Symptomatic Cerebral Artery Occlusion".JAMA .(2025)
医学