Abstract
Context: Despite overwhelming evidence for endovascular therapy in anterior circulation ischemic stroke due to large-vessel occlusion, data regarding the treatment of acute basilar artery occlusion (BAO) are still equivocal. The BASICS trial failed to show an advantage of endovascular therapy (EVT) over best medical treatment (BMT). In contrast, data from the recently published BASILAR registry showed a better outcome in patients receiving EVT.Objective: The aim of the study was to investigate the safety and efficacy of EVT plus BMT vs. BMT alone in acute BAO.Methods: We analyzed the clinical course and short-term outcomes of patients with radiologically confirmed BAO dichotomized by BMT plus EVT or BMT only as documented in a state-wide prospective registry of consecutive patients hospitalized due to acute stroke. The primary endpoint was a favorable functional outcome (mRS 0–3) at hospital discharge assessed as common odds ratio using binary logistic regression. Secondary subgroup analyses and propensity score matching were added. Safety outcomes included mortality, the rate of intracerebral hemorrhages, and complications during hospitalization.Results: We included 403 patients with acute BAO (2017–2019). A total of 270 patients (67%) were treated with BMT plus EVT and 133 patients (33%) were treated with BMT only. A favorable outcome (mRS 0–3) was observed in 33.8% of the BMT and 26.7% of the BMT plus EVT group [OR.770, CI (0.50–1.2)]. Subgroup analyses for patients with a NIHSS score > 10 at admission to the hospital revealed a benefit from EVT [OR 3.05, CI (1.03–9.01)].Conclusions: In this prospective, quasi population-based registry of patients hospitalized with acute BAO, BMT plus EVT was not superior to BMT alone. Nevertheless, our results suggest that severely affected BAO patients are more likely to benefit from EVT.
Highlights
Arterial occlusions of the posterior intracranial circulation account for about 20% of all ischemic strokes, and of these, an estimated 15% are due to basilar artery occlusion (BAO) (1)
We aimed to investigate the safety and efficacy of endovascular therapy (EVT) plus best medical treatment (BMT) vs. BMT alone in acute BAO using consecutive, quasi population-based, real-life data from our mandatory state-wide quality assurance registry
Patients from the BMT group were slightly older (73.4 ± 13.1 years, p = 0.06) than those in the BMT plus EVT group (71.1 ± 12.9 years, p = 0.06) and fewer patients in this group were functionally independent before the stroke (75.2 vs. 84.1%, p = 0.008)
Summary
Arterial occlusions of the posterior intracranial circulation account for about 20% of all ischemic strokes, and of these, an estimated 15% are due to basilar artery occlusion (BAO) (1). Whereas the benefit of endovascular therapy (EVT) in anterior circulation ischemic strokes due to large-vessel occlusion has been proven by several randomized trials, (3–7) the efficacy of EVT over standard medical care has not yet been unequivocally shown in BAO patients. Two randomized-controlled trials failed to prove additional benefit of EVT in patients with acute BAO (8, 9). A consecutive registry of patients with angiographically proven BAO showed that patients receiving EVT tend to benefit in terms of functional recovery after 90 days, whereas the differences in thrombolytic treatment and process times should be noted (10)
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