Carotid Occlusion Surgery Study (COSS)

The goal of this study is to test the hypothesis that surgical anastomosis of the superficial temporal artery to the middle cerebral artery (STA-MCA), when added to best medical therapy can reduce by 40%, despite peri-operative stroke and death, subsequent ipsilateral ischemic stroke (fatal and non-fatal) at two years in participants with recently ($ 120 days) symptomatic internal carotid artery occlusion and ipsilateral increased oxygen extraction fraction measured by positron emission tomography (PET). We will test this hypothesis by conducting a randomized, non-blinded, controlled trial in 372 participants randomized equally to surgical or non-surgical treatment. ,:J