Thrombectomy versus medical management for basilar artery occlusion with low-to-moderate symptoms (nihss

Abstract

Patients with acute basilar artery occlusion (BAO) and mild symptoms are poorly represented in thrombectomy studies. The recent BASICS randomized controlled trial suggested that thrombectomy could be beneficial in patients with BAO and moderate or severe deficit (National Institute of Health Stroke Scale [NIHSS] greater than or equal To 10) but did not find any benefit of thrombectomy over best medical treatment (BMT) in patients with low-to-mild symptoms (NIHSS <10). To compare thrombectomy and BMT in patients with BAO and low-to-mild symptoms (NIHSS <10). Prospective non-randomized multicenter study of all consecutive patients presenting with an acute and symptomatic BAO (confirmed on noninvasive brain imaging) to 8 comprehensive stroke centers in France between January 2012 and May 2019. Patients with an initial NIHSS<10 were divided into groups received either BMT or BMT + thrombectomy.Adjustments were made using propensity-score analysis to compare both groups in terms of efficacy and safety outcomes. The main outcome was the proportion of patients achieving a favorable outcome (mRS 0-2 or equal to pre-stroke mRS) at three months follow-up. Secondary outcomes included the proportion of excellent clinical outcome (mRS 0-1 or equal to pre-stroke mRS), good clinical outcome (mRS 0-3 or equal to pre-stroke mRS) and the mortality rate at 3 months follow-up. Safety outcomes included hemorrhagic transformation at day 1 and mortality at 3 months. A total of 127 patients were included in the present study: 64 patients in the thrombectomy group and 63 patients in the BMT group. There was no difference between groups for the rate of favorable or good clinical outcome at 3 months, and rates of mortality were not significantly different. After propensity-score adjustment, thrombectomy was associated with a significantly higher chance of excellent outcome at 3 months (mRS 0-1 or equal to pre-stroke mRS) (adjusted OR, 2.68; 95%CI, 1.04 to 6.90; P=0.041). Among patients with a stroke secondary to BAO and low-to-mild symptoms (NIHSS<10), thrombectomy is associated with increased chances of having no symptom or disability at 3 months. Déclaration de liens d'intérêts Les auteurs n'ont pas transmis leur déclaration de liens d'intérêts.