Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: A Propensity-Matched Analysis from the Attention Multicentre Registry

Tao, Chunrong; Qureshi, Adnan I; Yin, Yamei; Li, Jie; Li, Rui; Xu, Pengfei; Sun, Jun; Liao, Geng; Yue, Xincan; Shi, Hongchao; Liu, Yongchang; Ma, Z.Y.; Zhang, Jinghua; Xiao, Guodong; Bo, Xu; Xu, Chenghua; Su, Junfeng; Zhou, Wensheng; Huang, Shuchun; Yang, Weimin; Chen, Hongbing; Li, Wei; Liu, Dezhi; Yu, Chuanqing; Yuan, Guangxiong; Wan, Chaobin; Liang, Wenbao; Chen, Chun; Wang, Junjun; Wu, Yingchun; Cai, Xueli; Shen, Chunyun; Li, Kai; Pu, Fang; Wang, Ming; Chen, Zhongjun; Li, Tong; Chen, Guangsen; Sun, Yulin; Wang, Yan; Zhang, Hui; Chen, Jie; Xu, Xiaohui; Wang, Youmeng; Geng, Wanjie; Ni, Chuyuan; Chen, Changchun; Liu, Yan; Min, Jie; Zhang, Yongcheng; Liang, Yu‐Xiang; Wen, Chao; Baxter, Blaise; Nogueira, Raul G; Hu, Wei; Investigators, Attention Trial

doi:10.2139/ssrn.3955736

Cited by 8 publications

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“…The ATTENTION registry found no heterogeneity in the association of treatment (EVT versus MT) with outcome according to time to treatment after stroke onset (< 6 hours: adjusted RR 1.49, 1.12-1.83; versus 6-24 hours: adjusted RR 1.30, 1.02-1.65; interaction P=0.95). 12 Consistency of the relative treatment effect of EVT versus MT for acute BAO during the first 24 hours after stroke onset was also observed in another registry EDITORIAL July 5, 2022 Circulation. 2022;146:18-20.…”

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confidence: 74%

“…EVT was also associated with lower mortality at 90 days (36.9% versus 47.5%; adjusted RR, 0.78 [95% CI, 0.69-0.88]), but a higher incidence of symptomatic intracranial hemorrhage (sICH) within 3 days after admission (5.2% versus 0.9%; adjusted RR 7.77, 2.6-24) compared with MT. 12 The results of this large, nationwide registry-based, observational study suggest that EVT within 24 h of onset of acute BAO is associated with improved functional outcomes and survival at 90 days compared with MT.…”

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confidence: 79%

“…10,11 In this issue of Circulation, Tao and colleagues report the outcome of the ATTENTION registry (Endovascular Treatment for Acute Basilar Artery Occlusion) of 2134 patients with acute (<24 h) BAO who were enrolled prospectively and consecutively at 48 sites in China from 2017 to 2021, and followed for the primary outcome of a mRS 0 to 3 at 90 days. 12 The baseline characteristics of the participants were typical for a large cohort of hospitalized patients with BAO. 5,6,10,11 The median age of the patients was 65 years, and the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 21 (moderate to severe stroke).…”

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confidence: 99%

“…5,6 Most patients (n=1672) were selected for EVT (plus MT), whereas 462 were selected for MT alone. 12 Because selection for EVT or MT was not randomized, there was imbalance between the groups for several measured baseline characteristics. There was also likely imbalance between groups for several unmeasured factors.…”

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confidence: 99%

“…These weights were applied to the study population to create a subpopulation of 1722 patients, of whom 443 patients treated with MT were matched (according to the propensity score) in a 1:3 ratio to 1329 patients treated with EVT. 12,13 After propensity matching, EVT was associated with a higher proportion of patients achieving a favorable functional outcome at 90 days, as defined by the mRS 0 to 3 (40.4% EVT versus 28.5% MT; adjusted relative risk [RR], 1.42 [95% CI, 1.19-1.65]; absolute risk difference, 11.8% [95% CI, 6.9-16.7%]) and mRS 0 to 2 (33.8% versus 23.1%; adjusted RR, 1.45 [95% CI, 1.17-1.73]). EVT was also associated with lower mortality at 90 days (36.9% versus 47.5%; adjusted RR, 0.78 [95% CI, 0.69-0.88]), but a higher incidence of symptomatic intracranial hemorrhage (sICH) within 3 days after admission (5.2% versus 0.9%; adjusted RR 7.77, 2.6-24) compared with MT.…”

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confidence: 99%

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Endovascular Therapy for Acute Basilar Artery Occlusion

Hankey

2022

Circulation

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Section: Article See Pmentioning

confidence: 74%

Section: Article See Pmentioning

confidence: 79%

Section: Article See Pmentioning

confidence: 99%

Section: Article See Pmentioning

confidence: 99%

Section: Article See Pmentioning

confidence: 99%

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Endovascular Therapy for Acute Basilar Artery Occlusion

Hankey

2022

Circulation

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Current advances in endovascular treatment

Molad

Honig

2023

Current Opinion in Neurology

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Purpose of reviewEndovascular thrombectomy (EVT) is the most beneficial reperfusion therapy for acute ischemic stroke. Currently, much effort is done to promote trials examining EVT efficacy and safety in various conditions not included in the main randomized controlled trials established the superiority of EVT. This review summarizes the current advances of EVT patients selection and periprocedural management. Recent findingsRecent evidence points to beneficial effect of EVT among patients with relatively large ischemic core, premorbid independent nonagenarians and basilar artery occlusion, and suggest that intravenous thrombolysis bridging treatment is associated with better reperfusion rates. Ongoing trials currently examine EVT efficacy and safety in distal vessel occlusions and in large vessel occlusion with low NIHSS. Current evidence also support use of general anaesthesia and avoid postprocedural extremely low or high blood pressure as well as haemodynamic instability.

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Bridging thrombolysis improves survival rates at 90 days compared with direct mechanical thrombectomy alone in acute ischemic stroke due to basilar artery occlusion: a systematic review and meta-analysis of 1096 patients

Lee

Siow

Zhang

et al. 2022

J NeuroIntervent Surg

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BackgroundMechanical thrombectomy (MT) is an effective treatment for patients with acute ischemic stroke (AIS) from basilar artery occlusion (BAO).ObjectiveTo compare the clinical outcomes of MT, with and without bridging intravenous thrombolysis (IVT), in acute BAO through a systematic review and meta-analysis of the current literature.MethodsSystematic searches of Medline, EMBASE, and Cochrane Central were undertaken on August 1, 2022. Good functional outcome defined as 90-day modified Rankin Scale score 0–2 was the primary outcome measure. Secondary outcome measures were 90-day mortality, successful post-thrombectomy recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracranial hemorrhage (sICH), and subarachnoid hemorrhage (SAH).ResultsThree studies reporting 1096 patients with BAO AIS were included in the meta-analysis. No significant differences in good functional outcome were detected between the two groups (RR=1.28 (95% CI 0.86 to 1.92); p=0.117). However, specifically patients with large artery atherosclerosis (LAA) benefited from bridging IVT (OR=2.52 (95% CI 1.51 to 4.22); p<0.001) with better functional outcomes. There was a significantly lower 90-day mortality rate for patients who underwent bridging IVT compared with MT alone (RR=0.70 (95% CI 0.62 to 0.80); p=0.008). No significant differences were detected in rates of post-treatment recanalization (RR=1.01 (95% CI 0.35 to 2.91); p=0.954), sICH (RR=0.96 (95% CI 0.66 to 1.42); p=0.724), and SAH (RR=0.93 (95% CI 0.31 to 2.83); p=0.563).ConclusionsIn patients with AIS due to BAO, bridging IVT was associated with lower mortality rates at 90 days, compared with direct MT. There were no improved functional outcomes or increased sICH or SAH between both arms, However, patients with LAA benefited from bridging IVT, with better functional outcomes.

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Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: A Propensity-Matched Analysis from the Attention Multicentre Registry

Cited by 8 publications

References 0 publications

Endovascular Therapy for Acute Basilar Artery Occlusion

Endovascular Therapy for Acute Basilar Artery Occlusion

Current advances in endovascular treatment

Bridging thrombolysis improves survival rates at 90 days compared with direct mechanical thrombectomy alone in acute ischemic stroke due to basilar artery occlusion: a systematic review and meta-analysis of 1096 patients

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