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For the occlusion of the intracranial internal carotid artery (ICA), some people suggest to pass extracranial to intracranial (EC-IC), superficial temporal artery to middle cerebral artery (STA-MCA) The bypass strategy is to increase cerebral blood flow, but current practice is severely affected by the negative results of the COSS randomized controlled trial published in 2011
.
The purpose of the COSS trial is to investigate the efficacy of STA-MCA bypass surgery in patients with atherosclerotic unilateral internal artery occlusion (A-ICAO)
.
The main inclusion criteria were (1) vascular imaging showed complete occlusion of ICA, (2) clinical diagnosis of TIA or ischemic stroke in the hemisphere of the ICA blood supply area within 120 days, (3) PET showed the ratio of ipsilateral/contralateral oxygen uptake score> 1.
Figure 1.
The annual number of STA-MCA bypass surgeries from 2008 to 2019:
The annual number of STA-MCA bypass surgeries from 2008 to 2019 : Figure 1.
The annual number of STA-MCA bypass surgeries from 2008 to 2019:
The results of COSS will have a general impact on clinical decision-making.
Therefore, we analyzed the characteristics of patients undergoing arteriosclerosis vascular occlusion bypass surgery to assess whether these patients have different characteristics from the population reported in COSS
.
In October 2021, Peter Vajkoczy from Germany and others announced their research results on Stroke
They retrospectively analyzed all patients who were referred to their center for STA-MCA bypass surgery due to atherosclerotic cerebrovascular disease after the publication of COSS
.
Figure 2.
Examples of unilateral and bilateral hemodynamic impairment:
Examples of unilateral and bilateral hemodynamic impairment: Figure 2.
Examples of unilateral and bilateral hemodynamic impairment:
Between 2012 and 2019, 179 patients were referred to the Investigator Center for 186 bypass surgeries
.
Ninety-one patients (51%) had atherosclerotic unilateral internal carotid artery occlusion, and 88 patients (49%) had atherosclerotic polyvascular disease
According to the COSS inclusion criteria, in the past 120 days, only 36 (20%) of 179 patients had a TIA or ischemic stroke, and 27 (15%) had more than one TIA, and 109 (61 %) had recurrent mild ischemic stroke, 7 patients (4%) were hemodynamically unstable and needed to maintain blood pressure
.
There was no difference in the distribution of symptoms between the two groups of patients with atherosclerotic unilateral internal carotid artery occlusion and atherosclerotic polyvascular disease (P=0.
In the end, the author believes that compared with patients in the COSS trial, patients undergoing blood flow enhancement surgery today have more severe symptoms and vascular occlusion patterns
.
Considering that the prognosis of severe atherosclerotic cerebrovascular disease is still poor, it seems worthwhile to conduct a new, well-designed randomized controlled trial
Original source:
Original source:Lars Wessels, Nils Hecht and Peter Vajkoczy.
Patients Receiving Extracranial to Intracranial Bypass for Atherosclerotic Vessel Occlusion Today Differ Significantly From the COSS Population in this message
