Extracranial-intracranial Bypass Surgery for Symptomatic Chronic Middle Cerebral Artery Occlusion: the CMOSS-2 Trial

NCT ID: NCT05899582

Last Updated: 2025-03-28

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 420 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-09-15
• Study Completion Date: 2027-09-30

Brief Summary

The CMOSS-2 trial is a government-funded, prospective, multicenter, randomized controlled trial. It will recruit symptomatic chronic occlusion of the middle cerebral artery in patients with severe hemodynamic insufficiency. Only high-volume center with a proven track record will be included. Patients will be randomized (1:1) to best medical treatment alone or medical treatment plus bypass surgery. Primary outcome is ischemic stroke in the territory of the target artery within 24 months after randomization.

Detailed Description

Middle cerebral artery occlusion is an important cause of ischemic stroke, and there are currently two treatment methods: medical treatment alone and extracranial-intracranial bypass surgery (EC-IC bypass surgery). Previous studies have shown that the optimal medical treatment has an annual stroke recurrence rate of up to 10%, and patients with concomitant hemodynamic disorders can also increase by 7.3 times.

The CMOSS study was the first trial in China to evaluate the safety and efficacy of EC-IC bypass surgery on patients with ICA or MCA occlusion combined with hemodynamic insufficiency evaluated with CT perfusion. The results showed that there was no significant difference in the risk of stroke or death between the bypass group and the medical group, but there was a significant difference in ipsilateral ischemic stroke between 30 days and 2 years after randomization, with only 2.0% in the surgery group and 10.3% in the medical group; In addition, subgroup analysis found that for patients with MCA occlusion or severe hemodynamic insufficiency, bypass surgery has a potential beneficial trend over medical treatment alone.

The CMOSS-2 trial is a government-funded, prospective, multicenter, randomized controlled trial. It will recruit symptomatic chronic occlusion of the middle cerebral artery in patients with severe hemodynamic insufficiency. Only high-volume center with a proven track record will be included. Patients will be randomized (1:1) to best medical treatment alone or medical treatment plus bypass surgery. Primary outcome is ischemic stroke in the territory of the target artery within 24 months after randomization. The CMOSS-2 trial will be conducted in 13 sites in China.

Conditions

Symptomatic Chronic Middle Cerebral Artery Occlusion; Infarction, Middle Cerebral Artery

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Surgery

The patients in the surgical group will be treated with direct extracranial to intracranial bypass surgery plus best medical treatment.

Group Type: EXPERIMENTAL

Extracranial-Intracranial Bypass Surgery

Intervention Type: PROCEDURE

Extracranial-intracranial bypass surgery plus medical treatment

Medical treatment

The patients will receive medical treatment alone according to the AHA/ASA Stroke and Transient Ischemic Attack (TIA) Stroke Prevention Guidelines (2021 edition).

Group Type: ACTIVE_COMPARATOR

Medical treatment alone

Intervention Type: OTHER

Best medical treatment alone according to current clinical guidelines, including antiplatelet drugs (e.g. aspirin) and risk factor controls.

Interventions

Extracranial-Intracranial Bypass Surgery

Extracranial-intracranial bypass surgery plus medical treatment

Intervention Type: PROCEDURE

Medical treatment alone

Best medical treatment alone according to current clinical guidelines, including antiplatelet drugs (e.g. aspirin) and risk factor controls.

Intervention Type: OTHER

Other Intervention Names

Best medical treatment

Eligibility Criteria

Inclusion Criteria

1. Age of 18-65 years;

2. Confirmed as chronic occlusion of unilateral middle cerebral artery (MCA) by digital subtraction angiography (DSA) or computed tomography angiography (CTA). Other cerebral artery stenosis should be less than 50%.

3. CT perfusion demonstrates severe hemodynamic insufficiency in the territory of the qualifying MCA with MTT (symptomatic side) ≥ 6s or rCBF (symptomatic side/contralateral side) ≤ 0.8;

4. mRS score is 0-2 points;

5. A history of ischemic events (including<1/2 cerebral infarction in the middle cerebral artery supply area, or transient ischemic attack [TIA]) related to the qualifying artery within 12 months ;

6. The onset of acute stroke should be more than 1 month;

7. CT or MRI excludes large cerebral infarction (infarction>1/2 of the territory of the qualifying middle cerebral artery);

8. Patients or their guardians voluntarily participate of the study and sign the consent form.

Exclusion Criteria

1. History of intracranial hemorrhage, subarachnoid hemorrhage, subdural hemorrhage, or extradural hemorrhage within 6 weeks;

2. Unstable angina pectoris or myocardial infarction, congestive heart failure within 6 months;

3. Women who are pregnant or lactating;

4. Coagulation dysfunction or hemorrhagic tendency (e.g. INR > 1.5 and/or platelet count < 100,000 mcL);

5. Other diseases with a life expectancy of less than 2 years

6. Previous treatment with EC-IC bypass surgery

7. Known allergy or contraindication to aspirin or clopidogrel or other antiplatelet drugs.

8. Known cardiac conditions that may lead to cardiogenic embolism: including prosthetic valves, infective endocarditis, left atrial or left ventricular thrombosis, atrial fibrillation, sick sinus node syndrome, atrial mucinous tumor or cardiomyopathy, ejection fraction <25%;

9. Allergy to iodine or x-ray contrast, blood creatinine > 3.0 mg/dl or other contraindications to arteriography

10. Uncontrolled diabetes mellitus with fasting blood sugar (FBS) >16.7 mmol/L

11. Uncontrolled hypertension with a sitting systolic blood pressure >180 mmHg or a sitting diastolic blood pressure >110 mmHg;

12. Persistent worsening of neurological symptoms within 72 hours;

13. Severe liver dysfunction, defined as serum alanine transaminase (ALT) and/or glutamic oxalacetic transaminase (AST) > 3 times the upper limit of normal range;

14. Active peptic ulcer disease;

15. Having received a clinical trial drug or device within 30 days prior to screening, or being enrolled in another clinical trial;

16. Other diseases or medical history that, in the judgment of the investigator, may affect the efficacy or safety evaluation of this study.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Xuanwu Hospital, Beijing

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Liqun Jiao, MD

Role: PRINCIPAL_INVESTIGATOR

Xuanwu Hospital, Beijing

Locations

Xuanwu Hospital, Capital Medical University.

Beijing, , China

Site Status: RECRUITING

Countries

China

Central Contacts

Yan Ma, MD

Role: CONTACT

leavesyan@sina.com

13810669502

Tao Wang, MD

Role: CONTACT

wangtao_dr@sina.com

18810302298

Facility Contacts

Liqun Jiao, MD

Role: primary

liqunjiao@sina.cn

13911224991

Other Identifiers

CMOSS-2

Identifier Type: -

Identifier Source: org_study_id