Endovascular vs Medical Management of Acute Basilar Artery Occlusion
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Published:2024-08-26
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ISSN:2168-6149
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Container-title:JAMA Neurology
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language:en
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Short-container-title:JAMA Neurol
Author:
Li Rui1, Tao Chunrong1, Sun Jun1, Zhang Chao1, Xu Pengfei1, Yin Yamei1, Han Hongxing2, Yuan Guangxiong3, Cui Tao4, Zhou Peiyang5, Chen Wenhuo6, Zeng Guoyong7, Li Yuwen8, Ma Zhengfei9, Yu Chuanqing10, Su Junfeng11, Zhou Zhiming12, Chen Zhongjun13, Wang Li1, Luo Cong1, Jing Xiaozhong1, Wang Anmo1, Shen Nan1, Abdalkader Mohamad14, Nguyen Thanh N.1415, Qureshi Adnan I.16, Saver Jeffrey L.17, Nogueira Raul G.18, Hu Wei1, , Han Hongxing19, Wen Changming19, Xu Hui19, Liao Geng19, Sun Yaxuan19, Zhang Hui19, Chen Jie19, Yue Xincan19, Ma Xiuyao19, Xiao GuoDong19, Wang Li19, Liu Rui19, Yang Weimin19, Liu Wenhua19, Liu Yong19, Guo Fuqiang19, Cai Xueli19, Yin Bo19, Li Jinglun19, Fang Pu19, Shen Chunyun19, Ni Chuyuan19, Wang Hui19, Liu Liang19, Li Kai19, Wang Hao19, Gao Jun19, Yi Tingyu19, Wang Youmeng19, Wang Tao19, Shi Xueying19, Cao Zhihua19, Long Chen19, Chen Li19, Zhang Chi19, Bao Wei19, Liu Xinfeng19, Qun Sen19, Wang Zi19, Chen Juan19, Chen Lang19, Liu Tianlong19, Deng Kexue19, Yuan Shuya19, Zheng Menglong19, Wang Guoping19, Song Jianlong19, Fang Chuanqing19, Baxter Blaise W.19, Xu Gelin19, Yan Xiaoyan19, Gao Feng19, Jiao Liqun19, Ye Ruidong19, Zhang Yongwei19, Wu Cangjun19, Chen Hongbing19, Zhang Guang19
Affiliation:
1. Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China 2. Department of Neurology, Linyi People’s Hospital, Linyi, China 3. Department of Emergency, Xiangtan Central Hospital, Xiangtan, China 4. Department of Neurology, Taihe Country People’s Hospital, Fuyang, China 5. Department of neurology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China 6. Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China 7. Department of Neurology, Ganzhou People’s Hospital, Ganzhou, China 8. Department of Neurology, Heze Municipal Hospital, Heze, China 9. Department of Neurology, Suzhou Hospital of Anhui Medical University, Suzhou, China 10. Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China 11. Department of Neurology, Jingzhou Hospital Affiliated With Yangtze University, Jingzhou, China 12. Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China 13. Department of Neurointervention, Dalian Municipal Central Hospital Affiliated With Dalian Medical University, Dalian, China 14. Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 15. Department of Neurology, Boston University School of Medicine, Boston, Massachusetts 16. Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia 17. Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of Los Angeles, Los Angeles, California 18. The University of Pittsburgh School of Medicine Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 19. for the ATTENTION Investigators
Abstract
ImportanceIn several randomized clinical trials, endovascular thrombectomy led to better functional outcomes than conventional treatment at 90 days poststroke in patients with acute basilar artery occlusion. However, the long-term clinical outcomes of these patients have not been well delineated.ObjectiveTo evaluate 1-year clinical outcomes in patients with acute basilar artery occlusion following endovascular thrombectomy vs control.Design, Setting, and ParticipantsThis study is an extension of the ATTENTION trial, a multicenter, randomized clinical trial. Patients were included between February 2021 and January 2022, with 1-year follow-up through April 2023. This multicenter, population-based study was conducted at 36 comprehensive stroke sites. Patients with acute basilar artery occlusion within 12 hours of estimated symptom onset were included. Of the 342 patients randomized in the ATTENTION trial, 330 (96.5%) had 1-year follow-up information available.ExposuresEndovascular thrombectomy (thrombectomy group) vs best medical treatment (control group).Main Outcomes and MeasuresThe primary outcome was defined as a score of 0 to 3 on the modified Rankin Scale (mRS) at 1 year. Secondary outcomes were functional independence (mRS score 0-2), excellent outcome (mRS score 0-1), level of disability (distribution of all 7 mRS scores), mortality, and health-related quality of life at 1 year.ResultsAmong 330 patients who had 1-year follow-up data, 227 (68.8%) were male, and the mean (SD) age was 67.0 (10.7) years. An mRS score 0 to 3 at 1 year was achieved by 99 of 222 patients (44.6%) in the thrombectomy group and 21 of 108 (19.4%) in the control group (adjusted rate ratio, 2.23; 95% CI, 1.51-3.29). Mortality at 1 year compared with 90 days was more frequent in both the thrombectomy group (101 of 222 [45.5%] vs 83 of 226 [36.7%]) and the control group (69 of 108 [63.9%] vs 63 of 114 [55.3%]). Excellent outcome (mRS score 0-1) at 1 year compared with 90 days increased in the thrombectomy group (62 of 222 [27.9%] vs 45 of 226 [19.9%]) but not in the control group (9 of 108 [8.3%] vs 9 of 114 [7.9%]) resulting in a magnified treatment benefit.Conclusions and RelevanceAmong patients with basilar artery occlusion within 12 hours of onset, the benefits of endovascular thrombectomy at 1 year compared with 90 days were sustained for favorable (mRS score 0-3) outcome and enhanced for excellent (mRS score 0-1) outcome.
Publisher
American Medical Association (AMA)
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