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The Carotid Occlusion Surgery Study
Journal article   Open access   Peer reviewed

The Carotid Occlusion Surgery Study

Robert L Grubb Jr, William J Powers, Colin P Derdeyn, Harold P Adams Jr and William R Clarke
Neurosurgical focus, Vol.14(3), pp.e9-e9
03/15/2003
DOI: 10.3171/foc.2003.14.3.10
PMID: 15709726
url
https://doi.org/10.3171/foc.2003.14.3.10View
Published (Version of record) Open Access

Abstract

The St. Louis Carotid Occlusion Study demonstrated that ipsilateral increased O2 extraction fraction (OEF) (Stage II hemodynamic failure) measured by positron emission tomography (PET) is a powerful independent risk factor for subsequent stroke in patients with symptomatic complete carotid artery (CA) occlusion. The ipsilateral ischemic stroke rate at 2 years has been shown to be 5.3% in 42 patients with normal OEF and 26.5% in 39 patients with increased OEF (p = 0.004). In patients in whom hemispheric symptoms developed within 120 days, the 2-year ipsilateral stroke rates were 12% in 27 patients with normal OEF and 50% in 18 patients with increased OEF. Previous PET studies have demonstrated that anastomosis of the superficial temporal artery (STA) to a middle cerebral artery (MCA) cortical branch can restore OEF to normal. The authors discuss the undertaking of a study that will test the hypothesis that STA-MCA anastomosis, when combined with the best medical therapy, can reduce ipsilateral ischemic stroke by 40% at 2 years in patients with symptomatic internal CA occlusion and Stage II hemodynamic failure occurring within 120 days after surgery. Only patients with increased OEF distal to a symptomatic occluded CA will be randomized to surgery or medical treatment. The primary endpoint will be all strokes and death occurring between randomization and the 30-day postoperative cut off (with an equivalent period in the nonsurgical group), as well as subsequent ipsilateral ischemic stroke developing within 2 years. It is estimated that 186 patients will be required in each group. Assuming that 40% of PET scans will demonstrate increased OEF, this will require enrolling 930 clinically eligible individuals.
 Hemodynamics Carotid Artery Diseases - surgery Postoperative Complications - etiology Follow-Up Studies Outcome Assessment (Health Care) Randomized Controlled Trials as Topic - methods Humans Carotid Artery Diseases - complications Carotid Stenosis - drug therapy Postoperative Complications - prevention & control Positron-Emission Tomography Life Tables Patient Selection Carotid Artery Diseases - diagnostic imaging Carotid Artery, Internal - surgery Carotid Stenosis - surgery Carotid Artery Diseases - drug therapy Cerebral Revascularization Brain Ischemia - epidemiology Risk Factors Arterial Occlusive Diseases - diagnostic imaging Anticoagulants - therapeutic use Brain Ischemia - prevention & control Combined Modality Therapy Postoperative Complications - epidemiology Brain Ischemia - etiology Carotid Stenosis - complications Arterial Occlusive Diseases - drug therapy Arterial Occlusive Diseases - surgery Carotid Artery, Internal - diagnostic imaging Arterial Occlusive Diseases - complications Carotid Stenosis - diagnostic imaging Research Design

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