No benefit to bypass surgery vs medical treatment for symptomatic carotid/cerebral artery occlusion/insufficiency (CMOSS)

Clinical Question

Does bypass surgery plus medical therapy reduce the risk of stroke or death in adults with atherosclerotic occlusion of the internal carotid artery or middle cerebral artery versus medical therapy alone?

Bottom line

This study found no additional benefit of bypass surgery plus medical therapy over medical therapy alone after 2 years of follow-up in reducing the risk of stroke or death in adults with atherosclerotic occlusion of the ICA or the MCA. 1b

Study design: Randomized controlled trial (single-blinded)

Funding: Government

Setting: Inpatient (any location) with outpatient follow-up

Reviewer

David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC


Discuss this POEM


Comments

ARUP KUMAR DHARA

Impact assessment

Excellent

Pieter Richard Verbeek

No benefit to bypass surgery vs medical treatment for sympto

Some of the important outcomes were clinically relevant but not statistically different. One wonders whether the small sample size of this study was a factor. Secondly, although the study purports to have used improved patient selection and surgical techniques, recruitment started in 2013. It is hard to believe that no surgical techniques in 2013 were similar to those in 2018 when the study ended.

John MacDonald

reduce risk of needless side effects

such as surgically induced stroke

Anonymous

best to clarify

I think this study really says no benefit if stenosis is < 50% and > 50% sten was excluded.

Bertus Johannes Reitsma

long term outcome !

trust the authors will continue this study to complete 5 years FU

Anonymous

Medical therapy equivalent to carotid surgery

I am surprised at this data. I have assisted on carotid surgery for years and thought the data favoured endarterectomy.

Anonymous

No

No