The Carotid and Middle cerebral artery Occlusion Surgery Study (CMOSS): a study protocol for a randomised controlled trial

Trials. 2016 Nov 16;17(1):544. doi: 10.1186/s13063-016-1600-1.


Background: Patients with symptomatic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion with haemodynamic insufficiency are at high risk for recurrent stroke when treated medically.

Methods: The Carotid or Middle cerebral artery Occlusion Surgery Study (CMOSS) trial is an ongoing, government-funded, prospective, multicentre, randomised controlled trial. The CMOSS will recruit 330 patients with symptomatic ICA or MCA occlusion (parallel design, 1:1 allocation ratio) and haemodynamic insufficiency. Participants will be allocated to best medical treatment alone or best medicine plus extracranial-intracranial (EC-IC) bypass surgery. The primary outcome events are all strokes or deaths occurring between randomisation and 30 days post operation or post randomisation and ipsilateral ischaemic stroke within 2 years. Recruitment will be finished by December 2016. All the patients will be followed for at least 2 years. The trial is scheduled to complete in 2019.

Discussion: The CMOSS will test the hypothesis that EC-IC bypass surgery plus best medical therapy reduces subsequent ipsilateral ischaemic stroke in patients with symptomatic ICA or MCA occlusion and haemodynamic cerebral ischaemia. This manuscript outlines the rationale and the design of the study. CMOSS will allow for more critical reappraisal of the EC-IC bypass for selected patients in China.

Trial registration: NCT01758614 with Registered on 24 December 2012.

Keywords: Bypass surgery; Carotid artery; China; Haemodynamic; Ischaemic stroke; Middle cerebral artery; Occlusion.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cardiovascular Agents / adverse effects
  • Cardiovascular Agents / therapeutic use*
  • Carotid Artery, Internal* / diagnostic imaging
  • Carotid Artery, Internal* / physiopathology
  • Carotid Stenosis / diagnosis
  • Carotid Stenosis / mortality
  • Carotid Stenosis / physiopathology
  • Carotid Stenosis / therapy*
  • Cerebral Revascularization / adverse effects
  • Cerebral Revascularization / mortality
  • Cerebrovascular Circulation
  • China
  • Clinical Protocols
  • Collateral Circulation
  • Combined Modality Therapy
  • Female
  • Hemodynamics
  • Humans
  • Infarction, Middle Cerebral Artery / diagnosis
  • Infarction, Middle Cerebral Artery / mortality
  • Infarction, Middle Cerebral Artery / physiopathology
  • Infarction, Middle Cerebral Artery / therapy*
  • Male
  • Middle Aged
  • Prospective Studies
  • Recurrence
  • Research Design
  • Risk Factors
  • Risk Reduction Behavior*
  • Time Factors
  • Treatment Outcome
  • Young Adult


  • Cardiovascular Agents

Associated data