Basilar Artery Occlusion Chinese Endovascular Trial: Protocol for a prospective randomized controlled study

Abstract

Background and Purpose: For prevention of cerebrovascular diseases at younger age, it is important to understand the risk factors occurring early in life. We investigated the relationship between mothers’ general health during pregnancy and the offspring’s risk of cerebrovascular disease in age of 15 to 52 years. Methods: Within the population-based prospective Northern Finland Birth Cohort 1966, 11,926 persons were followed from antenatal period to 52 years of age. Information on their mother’s ill health conditions, i.e., hospitalizations, chronic diseases, medications, vitamin or iron supplement, fever, anemia, mood, and smoking was collected from 24th gestational week onwards. Ischemic and hemorrhagic cerebrovascular diseases of the offspring were identified from national registers in Finland. Cox proportional hazard models were used to estimate the association of mother’s health conditions with incidence of cerebrovascular disease in the offspring, with adjustments for potential confounders. Results: During 565,585 person-years of follow-up, 449 (2.8%) of the offspring had a cerebrovascular disease. Hospitalization during pregnancy was associated with an increased risk of cerebrovascular disease in the offspring (hazard ratio (HR)=1.49; 95% confidence interval (CI) 1.06-2.08) after adjustment for confounders, as was having more than three ill health conditions (HR=1.89; CI 1.14-3.11). Not using vitamin or iron supplement associated with increased risk for cerebrovascular disease in the offspring (HR=1.39; CI 1.01-1.89). Conclusions: The results suggest that the risk of cerebrovascular disease may start as early as during the antenatal period, and the health characteristics of mothers during pregnancy may play a role in cerebrovascular disease risk of the offspring.

Endovascular thrombectomy versus standard medical treatment for stroke patients with acute basilar artery occlusion: a systematic review and meta-analysis

“…There are two ongoing RCTs assessing endovascular treatment in patients with BAO. The BAOCHE trial (Basilar Artery Occlusion Chinese Endovascular Trial, ClinicalTrials.gov NCT02737189) aimed at assessing whether EVT using the Solitaire device can provide more benefit for BAO patients with a baseline NIHSS score ≥6 and within 6–24 hours from the onset of symptoms in comparison with SMT alone 39. The ATTENTION trial (Endovascular Treatment for Acute Basilar Artery Occlusion, ClinicalTrials.gov NCT04751708) is designed to compare the safety and efficacy of EVT over SMT for the treatment of BAO patients with a baseline NIHSS score ≥10 and within 12 hours from the onset of symptoms 40.…”

Endovascular Treatment for Posterior Circulation Stroke: Ways to Maximize Therapeutic Efficacy

“…In posterior circulation LVO, EVT was associated with improved functional outcomes in a large prospective multicenter registry [ 1 ], and successful reperfusion was associated with favorable outcomes in multiple studies ( Table 1 ) [ 2 - 5 ] and a recent systematic review [ 6 ]. While we wait for positive results of two recent randomized controlled trials (RCTs) [ 7 - 10 ], two RCTs failed to show the therapeutic efficacy of EVT [ 11 , 12 ]. A meta-analysis showed that compared with anterior circulation EVT (AC-EVT), outcomes of EVT for posterior circulation stroke (PC-EVT) were unfavorable, with higher rates of futile recanalization (poor outcomes despite successful recanalization) [ 13 ].…”

Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion

“…In anterior circulation LVO patients, there is a strong relationship between the number of MT passes and both successful reperfusion and functional outcome, with a detrimental effect of increasing passes on 3 month functional outcome 2–8. Whereas the benefit of MT in patients with basilar artery occlusion (BAO) has not yet been demonstrated in randomized trials,9–11 the trials faced substantial challenges including perceived lack of equipoise leading to cross-over or treatment outside the trial with subsequent slow enrollment and risk of inclusion bias.…”