Many physicians in the 1970s believed carotid artery bypass surgery provided benefit to patients at risk of having a first or recurrent stroke. But a large international clinical trial discredited the theory, and the procedure essentially disappeared from operating rooms in the United States.
Today some researchers think they have the imaging technology to identify a subset of patients with stroke whose response to medical treatment—anticoagulants or antiplatelet agents—is poor (subsequent stroke rate of 25% to 50% within 2 years) and who may benefit from bypass surgery.
William J. Powers, MD, a professor in the departments of neurology and radiology at Washington University School of Medicine in St Louis, and his colleagues have begun the Carotid Occlusive Surgery Study (COSS)—a $20-million randomized multicenter trial funded by the National Institute of Neurological Disorders and Stroke. The study is also being conducted by researchers at the University of Iowa.
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