What question did this study set out to answer?

To determine whether extracranial–intracranial arterial bypass surgery reduces the risk of ischemic stroke in patients with symptomatic atherosclerotic disease of the internal carotid or middle cerebral artery.

November 7, 1985New England Journal of Medicine

Failure of Extracranial–Intracranial Arterial Bypass to Reduce the Risk of Ischemic Stroke

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Implication

Randomized trial reveals bypass surgery fails to reduce stroke risk in symptomatic carotid and cerebral arterial disease, indicating no preventive benefit over standard medical care.

Key Points

To determine whether extracranial–intracranial arterial bypass surgery reduces the risk of ischemic stroke in patients with symptomatic atherosclerotic disease of the internal carotid or middle cerebral artery.
Randomized trial conducted in 1,377 patients with recent hemisphere strokes, retinal infarction, or transient ischemic attacks and atherosclerotic narrowing or occlusion of the ipsilateral internal carotid or middle cerebral artery.
Patients were randomly assigned to best medical care alone (n = 714) or best medical care combined with superficial temporal artery-to-middle cerebral artery bypass surgery (n = 663), with an average follow-up of 55.8 months.
Thirty-day surgical mortality was 0.6% and major stroke morbidity was 2.5%, with a postoperative bypass patency rate of 96%.
Nonfatal and fatal strokes occurred both more frequently and earlier in surgically treated patients, and survival analyses showed no benefit for major stroke, all-cause mortality, or ipsilateral ischemic stroke.
Surgical patients had significantly worse outcomes in subgroups with severe middle-cerebral-artery stenosis (n = 109, Mantel-Haenszel chi-square = 4.74) and persistent ischemic symptoms after internal-carotid-artery occlusion (n = 287, chi-square = 4.04).

Cite This Study

A 1985 study studied this question.

synapsesocial.com/papers/6a7d6801d85f1805a31cdf3b https://doi.org/10.1056/nejm198511073131904

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November 7, 1985New England Journal of Medicine

Failure of Extracranial–Intracranial Arterial Bypass to Reduce the Risk of Ischemic Stroke

View Full Paper

Ask AI

Bookmark

Discussion

Member takes

Implication

Randomized trial reveals bypass surgery fails to reduce stroke risk in symptomatic carotid and cerebral arterial disease, indicating no preventive benefit over standard medical care.

Key Points

To determine whether extracranial–intracranial arterial bypass surgery reduces the risk of ischemic stroke in patients with symptomatic atherosclerotic disease of the internal carotid or middle cerebral artery.
Randomized trial conducted in 1,377 patients with recent hemisphere strokes, retinal infarction, or transient ischemic attacks and atherosclerotic narrowing or occlusion of the ipsilateral internal carotid or middle cerebral artery.
Patients were randomly assigned to best medical care alone (n = 714) or best medical care combined with superficial temporal artery-to-middle cerebral artery bypass surgery (n = 663), with an average follow-up of 55.8 months.
Thirty-day surgical mortality was 0.6% and major stroke morbidity was 2.5%, with a postoperative bypass patency rate of 96%.
Nonfatal and fatal strokes occurred both more frequently and earlier in surgically treated patients, and survival analyses showed no benefit for major stroke, all-cause mortality, or ipsilateral ischemic stroke.
Surgical patients had significantly worse outcomes in subgroups with severe middle-cerebral-artery stenosis (n = 109, Mantel-Haenszel chi-square = 4.74) and persistent ischemic symptoms after internal-carotid-artery occlusion (n = 287, chi-square = 4.04).

Cite This Study

A 1985 study studied this question.

synapsesocial.com/papers/6a7d6801d85f1805a31cdf3b https://doi.org/10.1056/nejm198511073131904

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