Endovascular Treatment for Posterior Circulation Stroke in Routine Clinical Practice: Results of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry

Abstract

BACKGROUND AND PURPOSE: The benefit of endovascular treatment (EVT) for posterior circulation stroke (PCS) remains uncertain, and little is known on treatment outcomes in clinical practice. This study evaluates outcomes of a large PCS cohort treated with EVT in clinical practice. Simultaneous to this observational study, several intervention centers participated in the BASICS trial (Basilar Artery International Cooperation Study), which tested the efficacy of EVT for basilar artery occlusion in a randomized setting. We additionally compared characteristics and outcomes of patients treated outside BASICS in trial centers to those from nontrial centers. Methods: We included patients with PCS from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry: a prospective, multicenter, observational study of patients who underwent EVT in the Netherlands between 2014 and 2018. Primary outcome was a score of 0 to 3 on the modified Rankin Scale at 90 days. Secondary outcomes included reperfusion status and symptomatic intracranial hemorrhage. For outcome comparison between patients treated in trial versus nontrial centers, we used ordinal logistic regression analysis. Results: We included 264 patients of whom 135 (51%) had received intravenous thrombolysis. The basilar artery was most often involved (77%). Favorable outcome (modified Rankin Scale score 0–3) was observed in 115/252 (46%) patients, and 109/252 (43%) patients died. Successful reperfusion was achieved in 178/238 (75%), and symptomatic intracranial hemorrhage occurred in 9/264 (3%). The 154 nontrial patients receiving EVT in BASICS trial centers had similar characteristics and outcomes as the 110 patients treated in nontrial centers (modified Rankin Scale adjusted cOR: 0.77 [95% CI, 0.5–1.2]). Conclusions: Our study shows that high rates of favorable clinical outcome and successful reperfusion can be achieved with EVT for PCS, despite high mortality. Characteristics and outcomes of patients treated in trial versus nontrial centers were similar indicating that our cohort is representative of clinical practice in the Netherlands. Randomized studies using modern treatment approaches are needed for further insight in the benefit of EVT for PCS.

Outcomes of Endovascular Therapy in Young Patients with Acute Basilar Artery Occlusion: A Substudy of BASILAR Registry Study

“…Basilar artery occlusion (BAO) accounts for 1% of ischemic strokes and 10% of large artery occlusions and is associated with high morbidity and mortality [ 1 , 2 ]. Pooled analysis has demonstrated the benefit of endovascular therapy (EVT) for patients with acute BAO [ 3 , 4 ]. Although the recent randomized trials failed to verify the superiority of EVT over standard medical therapy in patients with acute BAO, a substantial benefit of EVT could not be excluded because of inherent limitations of the two trials, such as high crossover rate [ 5 ] and poor recruitment [ 6 ].…”

Influencing factors of futile recanalization after endovascular therapy for cerebral infarction with posterior circulation occlusion of large vessels: a retrospective study

“…However, there are some large studies did not confirm that intravascular interventional therapy in the time window is superior to medical treatment alone for acute posterior circulation large-vessel occlusion stroke, including the BEST [ 19 ] and BASICS studies [ 20 ]. It is worth noting that the inclusion and exclusion criteria of the above studies were different, and different inclusion and exclusion criteria may lead to different and invalid recanalization rates, thus making the intravascular interventional treatment of posterior circulation large vessel occlusion cerebral infarction ambiguous in clinical practice [ 21 ]. Therefore, we consider that there are significant influencing factors for ineffective recanalization after EVT in cerebral infarction with posterior circulation large vessel occlusion.…”

Etiology of Large Vessel Occlusion Posterior Circulation Stroke: Results of the MR CLEAN Registry

“…Full methods of the MR CLEAN registry have been reported previously. 11 Source data will not be made available because of legislative issues on patient privacy but detailed analytic methods and study materials, including log files of statistical analyses, will be made available to other researchers on reasonable request to the first author. This article adheres to the STROBE guidelines which can be found in the Supplemental Material.…”