{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:44:24Z","timestamp":1786124664632,"version":"build-2736575974"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2019,9,11]],"date-time":"2019-09-11T00:00:00Z","timestamp":1568160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>There are limited data on outcomes of extracranial-intracranial (EC-IC) bypass in patients with recurrent hemispheric syndromes due to atherosclerotic internal carotid artery occlusion (AICAO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To compare clinical outcomes and efficacy of EC-IC bypass surgery in patients with and without recurrent hemispheric syndromes associated with AICAO in the Carotid Occlusion Surgery Study (COSS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>In patients enrolled in the COSS trial, we compared baseline characteristics and clinical outcomes for participants with (rHEMI+) and without recurrent hemispheric ischemia (rHEMI\u2212) prior to randomization into surgical vs medical groups. The primary outcome was all stroke and death from randomization through 30 d and ipsilateral ischemic stroke within 2 yr.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Of 195 randomized participants, 100 were rHEMI+ (50 in each group). Baseline characteristics between rHEMI+ and rHEMI\u2212 participants were similar except rHEMI+ were more likely to have had previous stroke prior to randomization (61% vs 20%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.01) and to have TIA as the entry event (59% vs 21%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.01). All primary endpoints were ipsilateral ischemic strokes. There were no significant differences in occurrence of the primary endpoint between nonsurgical and surgical participants in rHEMI+ (26.3% vs 22.4%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.660) and rHEMI\u2212 (18.9% vs 19.5%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.943). For nonsurgical participants, there was no significant difference in the primary endpoint for rHEMI+ vs rHEMI\u2212 patients (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.410)\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Patients with recurrent hemispheric stroke syndromes enrolled in the COSS trial did not show benefit from EC-IC bypass compared to medical treatment. Early aggressive risk factor measures should be prioritized to reduce recurrent strokes in these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyz352","type":"journal-article","created":{"date-parts":[[2019,9,9]],"date-time":"2019-09-09T15:28:40Z","timestamp":1568042920000},"page":"137-141","source":"Crossref","is-referenced-by-count":14,"title":["Recurrent Hemispheric Stroke Syndromes in Symptomatic Atherosclerotic Internal Carotid Artery Occlusions: The Carotid Occlusion Surgery Study Randomized Trial"],"prefix":"10.1227","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1710-9881","authenticated-orcid":false,"given":"Fadi","family":"Nahab","sequence":"first","affiliation":[{"name":"Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Liu","sequence":"additional","affiliation":[{"name":"Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haseeb A","family":"Rahman","sequence":"additional","affiliation":[{"name":"Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srikant","family":"Rangaraju","sequence":"additional","affiliation":[{"name":"Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Barrow","sequence":"additional","affiliation":[{"name":"Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C Michael","family":"Cawley","sequence":"additional","affiliation":[{"name":"Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L","family":"Grubb","sequence":"additional","affiliation":[{"name":"Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin P","family":"Derdeyn","sequence":"additional","affiliation":[{"name":"University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harold P","family":"Adams","sequence":"additional","affiliation":[{"name":"University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom O","family":"Videen","sequence":"additional","affiliation":[{"name":"Santa Fe, New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Bridget","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J","family":"Powers","sequence":"additional","affiliation":[{"name":"University of North Carolina, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the COSS Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,7]]},"reference":[{"issue":"6","key":"bib1-20231011","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s11936-003-0039-3","article-title":"Atherosclerotic carotid artery occlusion","volume":"5","author":"Powers","year":"2003","journal-title":"Curr Treat Options Cardio Med"},{"issue":"8","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"e349","DOI":"10.1161\/01.STR.0000135024.54608.3f","article-title":"Population-based study of symptomatic internal carotid artery occlusion: incidence and long-term follow-up","volume":"35","author":"Flaherty","year":"2004","journal-title":"Stroke"},{"issue":"12","key":"bib3-20231011","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1001\/jama.280.12.1055","article-title":"Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion","volume":"280","author":"Grubb","year":"1998","journal-title":"JAMA"},{"issue":"18","key":"bib4-20231011","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.1001\/jama.2011.1610","article-title":"Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia the carotid occlusion surgery study randomized trial","volume":"306","author":"Powers","year":"2011","journal-title":"JAMA"},{"issue":"19","key":"bib5-20231011","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1056\/NEJM198511073131904","article-title":"Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke","volume":"313","author":"Barnett","year":"1985","journal-title":"N Engl J Med"},{"issue":"9","key":"bib6-20231011","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1212\/WNL.0000000000000167","article-title":"Randomized Evaluation of Carotid Occlusion and Neurocognition (RECON) trial: main results","volume":"82","author":"Marshall","year":"2014","journal-title":"Neurology"},{"issue":"3","key":"bib7-20231011","doi-asserted-by":"crossref","first-page":"E772","DOI":"10.1227\/NEU.0b013e318268c7d3","article-title":"Commentary: extracranial intracranial bypass for stroke in 2012: response to the critique of the carotid occlusion surgery study \u201cIt was d\u00e9j\u00e0 vu all over again\u201d","volume":"71","author":"Powers","year":"2012","journal-title":"Neurosurgery"},{"issue":"12","key":"bib8-20231011","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1212\/WNL.0000000000000238","article-title":"Lower stroke risk with lower blood pressure in hemodynamic cerebral ischemia","volume":"82","author":"Powers","year":"2014","journal-title":"Neurology"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/neurosurgery\/article-pdf\/87\/1\/137\/37868827\/nyz352.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyz352","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:43:59Z","timestamp":1786121039000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyz352"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,11]]},"references-count":8,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyz352","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,11]]}}}