Abstract
Background and Purpose: It is unknown the benefit of endovascular therapy (EVT) for progressive stroke in patients with basilar artery occlusion (BAO). The aim of this study was to compare the efficacy and safety of EVT with standard medical therapy (SMT) in a population of BAO patients with progressive stroke.Methods: The EVT for Acute Basilar Artery Occlusion Study (BASILAR) is a national prospective registry of consecutive patients with acute BAO within 24 h of symptom onset. According to the applied therapy, all patients were divided into SMT and EVT groups. Subsequently, the EVT group was divided into early (≤6 h) and late groups (>6 h) according to the time window. The efficacy outcome was favorable functional outcomes (modified Rankin Scale score ≤ 3) at 90 days. The safety outcomes included mortality within 90 days and symptomatic intracerebral hemorrhage (sICH) after EVT.Results: The EVT cohort presented more frequently with a favorable functional outcome (adjusted odds ratio, 5.49; 95% confidence interval, 2.06–14.61, p = 0.01) and with a decreased mortality (adjusted odds ratio, 0.3; 95% confidence interval, 0.17–0.54, p < 0.001). What's more, EVT still safe (P = 0.584, P = 0.492, respectively) and effective (P = 0.05) in patients with progressive stroke when the treatment time window exceeds 6 h.Conclusions: EVT was more effective and safer than SMT for progressive stroke in patients with BAO. Besides, EVT remains safe and effective in patients with progressive stroke when the treatment time window exceeds 6 h. Predictors of desirable outcome in progressive stroke patients undergoing EVT included lower baseline NIHSS score, higher baseline pc-ASPECTs, successful recanalization and shorter puncture to recanalization time.
Highlights
Posterior circulation stroke has a high mortality and disability rate, especially when caused by basilar artery occlusion (BAO) [1]
Several prospective studies have showed that patients with BAO treated with endovascular therapy (EVT) may have better functional outcomes than those treated with standard medical therapy (SMT) alone [2, 3]
Eight hundred and twenty-nine acute BAO patients from 47 stroke sites in China were enrolled in the BASILAR registry
Summary
Posterior circulation stroke has a high mortality and disability rate, especially when caused by basilar artery occlusion (BAO) [1]. Recent studies have shown the effectiveness and safety of EVT in patients with progressive stroke due to large vessel occlusion in the anterior circulation. A study has shown that EVT is a safe treatment option for patients with progressive stroke due to anterior circulation infarction, even beyond the 6-h time window [9]. The clinical outcome of EVT in patients with progressive stroke in acute BAO beyond 6 h is unknown It is unknown the benefit of endovascular therapy (EVT) for progressive stroke in patients with basilar artery occlusion (BAO). The aim of this study was to compare the efficacy and safety of EVT with standard medical therapy (SMT) in a population of BAO patients with progressive stroke
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