Effect of endovascular treatment within 6 hours for acute basilar artery occlusion

Jie YangDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Fengli LiDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Zhongming QiuDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Yan WangDepartment of Neurology, Chengdu Fifth People’s Hospital, Chengdu;

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Jun LuoDepartment of Neurology, Sichuan Mianyang 404 Hospital, Mianyang;

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Youlin WuDepartment of Neurology, Chongzhou People’s Hospital, Chongzhou;

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Guoyong ZengDepartment of Neurology, Ganzhou People’s Hospital, Ganzhou; and

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Yue WanDepartment of Neurology, Yangluo District of Hubei Zhongshan Hospital, Wuhan, China

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Shuai LiuDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Chengsong YueDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Jiaxing SongDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Weidong LuoDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Chang LiuDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Linyu LiDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Ruidi SunDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Jiacheng HuangDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Hongfei SangDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Chenhao ZhaoDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Qingwu YangDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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Wenjie ZiDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing;

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OBJECTIVE

The aim of this study was to investigate the efficacy and safety of endovascular treatment (EVT) plus standard medical treatment (SMT) in patients with acute basilar artery occlusion (BAO) within 6 hours of the estimated occlusion time, based on a Chinese population.

METHODS

The authors selected patients from the Endovascular Treatment of Acute Basilar Artery Occlusion Study (BASILAR) registry, which was a nationwide prospective registry, within 6 hours after the estimated time of onset of a stroke in acute BAO. Patients were divided into the SMT-alone group or the EVT+SMT group according to treatment modalities. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale score between 0 and 3 at 90 days. Safety outcomes included death at 90 days and symptomatic intracerebral hemorrhage.

RESULTS

The authors assessed 590 patients for eligibility. Of these patients, 127 received SMT alone and 463 were treated with EVT plus SMT. EVT was associated with a higher rate of a favorable functional outcome (adjusted OR 3.804, 95% CI 1.890–7.658; p < 0.001) and a lower proportion of deaths at 90 days (adjusted OR 0.364, 95% CI 0.223–0.594; p < 0.001). Lower age (adjusted OR 0.978, 95% CI 0.960–0.997; p = 0.022); lower baseline National Institutes of Health Stroke Scale score (adjusted OR 0.926, 95% CI 0.902–0.950; p < 0.001); higher baseline posterior circulation Alberta Stroke Program Early CT Score (adjusted OR 1.681, 95% CI 1.424–1.984; p < 0.001); absence of diabetes mellitus (adjusted OR 0.482, 95% CI 0.267–0.871; p = 0.016); and modified Thrombolysis in Cerebral Infarction scores 2b–3 (adjusted OR 5.117, 95% CI 2.304–11.367; p < 0.001) were independent factors for a favorable outcome in the EVT+SMT group.

CONCLUSIONS

Based on the study design, patients with acute BAO who received EVT within 6 hours were associated with improved favorable outcome and decreased deaths compared with patients who received SMT. Predictors of desirable outcome in patients undergoing EVT included lower age, lower baseline National Institutes of Health Stroke Scale score, higher baseline posterior circulation Alberta Stroke Program Early CT Score, absence of diabetes mellitus, and modified Thrombolysis in Cerebral Infarction scores 2b–3.

ABBREVIATIONS

BA = basilar artery; BAO = BA occlusion; BASICS = Basilar Artery International Cooperation Study; BASILAR = Endovascular Treatment of Acute Basilar Artery Occlusion Study; BEST = Endovascular Treatment versus Standard Medical Treatment for Vertebrobasilar Artery Occlusion; EVT = endovascular treatment; IQR = interquartile range; IVT = intravenous thrombolysis; mRS = modified Rankin Scale; mTICI = modified Thrombolysis in Cerebral Infarction; NIHSS = National Institutes of Health Stroke Scale; pc-ASPECTS = posterior circulation Alberta Stroke Program Early CT Score; PC-CS = posterior circulation collateral score; RCT = randomized controlled trial; rt-PA = recombinant tissue plasminogen activator; SMT = standard medical treatment.

Supplementary Materials

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Figure from Ramos et al. (pp 95–103).

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