{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T11:37:23Z","timestamp":1760441843963,"version":"3.40.3"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Previous trials have failed to demonstrate the benefits of extracranial-intracranial (EC-IC) bypass surgery for patients with carotid or middle cerebral artery occlusion. However, little evidence has focused on the effect of age on prognosis. This study aimed to explore whether EC-IC bypass surgery can provide greater benefits than medical therapy alone in specific age groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>A post hoc analysis was performed of the CMOSS (Carotid or Middle Cerebral Artery Occlusion Surgery Study), which was a randomized, open-label, outcome assessor-blinded trial conducted at 13 centers in China between June 2013 and March 2018. A total of 324 patients with internal carotid artery or middle cerebral artery occlusion with transient ischemic attack or nondisabling ischemic stroke attributed to hemodynamic insufficiency were randomized into a surgical group (n=161) that underwent EC-IC bypass surgery with medical therapy, and a medical group (n=163) that received antiplatelet therapy and stroke risk factor control alone. The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days up to 2 years after randomization. Receiver operating characteristic curves were drawn to explore the optimal age boundary, and survival analyses were used to explore differences between groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Among the 324 patients (median age, 52.7 years; 79.3% men), an age cutoff of 55.5 years predicted the primary outcome in the surgical group (area under the curve, 0.649 [95% CI, 0.530\u20130.769]). Patients were further divided into an older group (&gt;55.5 years) and a younger group (\u226455.5 years). Younger patients who underwent bypass surgery showed a lower risk of the primary outcome (log-rank\n              <jats:italic>P<\/jats:italic>\n              =0.001) than older patients. Patients who underwent EC-IC bypass surgery had a lower risk than patients with medical therapy alone in the younger group (3.2% versus 11.6%; hazard ratio, 0.255 [95% CI, 0.071\u20130.916];\n              <jats:italic>P<\/jats:italic>\n              =0.036), but not in the older group (17.5% versus 13.3%; adjusted hazard ratio, 0.597 [95% CI, 0.225\u20131.580];\n              <jats:italic>P<\/jats:italic>\n              =0.298).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>In patients aged 55.5 years or younger with symptomatic atherosclerotic occlusion of the internal carotid artery or middle cerebral artery and hemodynamic insufficiency, the addition of EC-IC bypass surgery to medical therapy significantly improved prognosis. These findings suggest that the clinical application of EC-IC bypass surgery needs more research to explore refined patient selection criteria incorporating more clinical features.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT01758614.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.124.048766","type":"journal-article","created":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T10:01:01Z","timestamp":1735293661000},"page":"362-370","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Determining the Optimal Age for Extracranial-Intracranial Bypass Surgery: A Post Hoc Analysis of the CMOSS Randomized Trial"],"prefix":"10.1161","volume":"56","clinical-trial-number":[{"clinical-trial-number":"nct01758614","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1235-3046","authenticated-orcid":true,"given":"Xin","family":"Li","sequence":"first","affiliation":[{"name":"Department of Neurosurgery (X.L., Y.L., T.W., X.S., G.L., R.Y., J.L., X.B., Y.M.), Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China."},{"name":"Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China (X.L., T.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1590-1035","authenticated-orcid":true,"given":"Yaowei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (X.L., Y.L., T.W., X.S., G.L., R.Y., J.L., X.B., Y.M.), Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China."},{"name":"Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China (Y.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1225-0173","authenticated-orcid":true,"given":"Tao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (X.L., Y.L., T.W., X.S., G.L., R.Y., J.L., X.B., Y.M.), Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyi","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (X.L., Y.L., T.W., X.S., G.L., R.Y., J.L., X.B., Y.M.), Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guangdong","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (X.L., Y.L., T.W., X.S., G.L., R.Y., J.L., X.B., Y.M.), Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China."},{"name":"Department of Interventional Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (G.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2175-8117","authenticated-orcid":true,"given":"Xinjuan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University and Shanxi Cardiovascular Hospital, Taiyuan, China (X.X., Y.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2449-591X","authenticated-orcid":true,"given":"Renjie","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (X.L., Y.L., T.W., X.S., G.L., R.Y., J.L., X.B., Y.M.), Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8341-0966","authenticated-orcid":true,"given":"Jichang","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (X.L., Y.L., T.W., X.S., G.L., R.Y., J.L., X.B., Y.M.), Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4324-1181","authenticated-orcid":true,"given":"Xuesong","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (X.L., Y.L., T.W., X.S., G.L., R.Y., J.L., X.B., Y.M.), Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoguang","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huanhu Hospital, Tianjin, China (X.T.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4580-2205","authenticated-orcid":true,"given":"Yuxiang","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Fudan University, National Center for Neurological Disorders, Shanghai, China (Y.G.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiyue","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Fudan University, National Center for Neurological Disorders, Shanghai, China (Y.G.)."},{"name":"Department of Neurosurgery, Liaocheng People\u2019s Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Liaocheng City, China (J.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0092-8375","authenticated-orcid":true,"given":"Zhiyong","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China (Z.T.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yufeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University and Shanxi Cardiovascular Hospital, Taiyuan, China (X.X., Y.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiling","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Neurology, Strategic Support Force Medical Center, Beijing, China (Y.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Second Hospital of Lan Zhou University, China (J.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donghai","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China (D.W.)."},{"name":"Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China (D.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7210-056X","authenticated-orcid":true,"given":"Lian","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Medical Center of Chinese People\u2019s Liberation Army General Hospital, Beijing, China (L.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aisha","family":"Maimaitili","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (A.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunhua","family":"Hang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanjing Drum Tower Hospital, Neurosurgical Institute of Nanjing University, Nanjing University Medical School, China (C.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0996-1492","authenticated-orcid":true,"given":"Jiasheng","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (J.Y.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0250-227X","authenticated-orcid":true,"given":"Tong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China (X.L., T.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0427-9566","authenticated-orcid":true,"given":"Yan","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (X.L., Y.L., T.W., X.S., G.L., R.Y., J.L., X.B., Y.M.), Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4982-6295","authenticated-orcid":true,"given":"Liqun","family":"Jiao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Interventional Neuroradiology (L.J.), Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the CMOSS 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History"}},{"value":"2024-11-04","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}