In basilar artery occlusion, endovascular thrombectomy within 12 hours of onset improved functional outcomes at 90 days versus best medical management alone.
“Despite the overwhelming benefit of endovascular thrombectomy (EVT) for treating anterior circulation large vessel occlusions, it remains unknown whether EVT is beneficial for acute basilar artery occlusion (BAO),” said study presenter Raul Nogueira, MD.
For this multicenter, prospective, randomized, controlled ATTENTION trial of EVT for BAO, 36 comprehensive centers in China participated. The study objective was to evaluate the hypothesis that EVT is superior to best medical management (BMM) alone in achieving more favorable outcomes at 90 days in participants presenting with acute BAO stroke within 12 hours of the estimated onset.
The intention-to-treat population consisted of 340 participants, of whom 226 were assigned to the thrombectomy group and 114 to the BMM group. The primary outcome was good functional status, defined as a score of 0-3 on the modified Rankin scale after 90 days.
One-third of participants received IV thrombolysis: 31% in the thrombectomy group and 34% in the control group. The primary endpoint was met by 104 patients (46%) in the thrombectomy group and by 26 (23%) in the control group (adjusted relative risk [RR], 2.06; P<0.001), with a number needed to treat of four. The risk difference was 23.2% (P<0.001). Symptomatic intracranial hemorrhage occurred in 12 patients (5%) in the thrombectomy group and none in the control group. Results for the secondary clinical and imaging outcomes largely went in the same direction as those for the primary outcome.
In the EVT and the control group, 31 (13.7%) and 2 (1.8%) participants, respectively, had an asymptomatic intracranial hemorrhage (ICH) at 24-72 hours. At 90 days, 83 patients (36.7%) in the EVT group and 63 patients (55.3%) in the control group presented with an asymptomatic ICH (adjusted RR, 0.66). Procedural complications occurred in 15% of participants in the thrombectomy group.
As Dr. Nogueira pointed out, Asian patients have relatively high rates of intracranial atherosclerotic disease, which limits the extent to which these findings can be generalized to Western patients. He added that the overall results of the ATTENTION trial are consistent with modern-era observational studies, large registries, and meta-analyses. The reduction in disability associated with EVT in BAO appears to be within the range of benefits observed in the anterior circulation.
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