Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: Results From the ATTENTION Multicenter Registry-Reference-Cited by-同舟云学术

Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: Results From the ATTENTION Multicenter Registry

Published:2022-07-05 Issue:1 Volume:146 Page:6-17
ISSN:0009-7322
Container-title:Circulation
language:en
Short-container-title:Circulation

Author:

Tao Chunrong¹,Qureshi Adnan I.²^ORCID,Yin Yamei¹,Li Jie¹,Li Rui¹,Xu Pengfei¹,Sun Jun¹,Liao Geng³,Yue Xincan⁴,Shi Hongchao⁵,Liu Yongchang⁶,Ma Zhengfei⁷,Zhang Jinhua⁸^ORCID,Xiao Guodong⁹,Xu Bo¹⁰,Xu Chenghua¹¹,Su Junfeng¹²,Zhou Wensheng¹³,Huang Shuchun¹⁴,Yang Weimin¹⁵,Chen Hongbing¹⁶,Li Wei¹⁷,Li Yongkun¹⁸,Liu Dezhi¹⁹,Yu Chuanqing²⁰,Yuan Guangxiong²¹,Wang Chaobin²²,Liang Wenbao²³,Chen Chun²⁴,Shi Xueying²⁵,Wang Junjun²⁶,Wu Yingchun²⁶,Cai Xueli²⁷,Shen Chunyun²⁸,Li Kai²⁹,Fang Pu³⁰,Wang Ming³¹,Chen Zhongjun³²,Li Tong³³,Cheng Guangsen³⁴,Sun Yaxuan³⁵,Wang Yan³⁶³⁷,Zhang Hui³⁸,Chen Jie³⁹,Xu Xiaohui⁴⁰,Wang Youmeng⁴¹,Geng Wanjie⁴²,Ni Chuyuan⁴³,Chen Changchun⁴⁴,Liu Yan⁴⁵^ORCID,Min Jie⁴⁶,Zhang Yongcheng⁴⁷,Liang Yong⁴⁸,Wen Chao⁴⁹,Baxter Blaise W.⁵⁰,Nogueira Raul G.⁵¹^ORCID,Hu Wei¹^ORCID,

Affiliation:

1. Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei Anhui, 230001, China (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.).

2. Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis (A.I.Q.).

3. Department of Neurology, Maoming People’s Hospital, Guangdong, China (G.L.).

4. Department of Neurosurgery, Zhoukou Central Hospital, China (X.Y.).

5. Department of Neurology, Nanjing First Hospital, China (H.S.).

6. Department of Neurovascular Intervention, Cangzhou Central Hospital, China (Yongchang Liu).

7. Department of Neurology, Suzhou Municipal Hospital, China (Z.M.).

8. Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z.).

9. Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, China (G.X.).

10. Department of Neurology, Qingdao Central Hospital, Qingdao University, China (B.X.).

11. Department of Neurology, Taizhou First People’s Hospital, China (C.X.).

12. Department of Neurology, Jingzhou Central Hospital, China (J.Su).

13. Department of Neurology, Hunan Provincial People’s Hospital, Changsha, China (W.Z.).

14. Department of Neurology, Hospital 302 Attached to Guizhou Aviation Group, Guizhou, China (S.H.).

15. Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China (W.Y.).

16. Department of Neurology and Stroke Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (H.C.).

17. Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, China (W.Li).

18. Department of Neurology, Fujian Provincial Hospital, Fuzhou, China (Y.Li).

19. Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, China (D.L.).

20. Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China (C.Y.).

21. Department of Emergency, Xiangtan Central Hospital, China (G.Y.).

22. Department of Neurology, Liangxiang Hospital, Fangshan District, Beijing, China (C.W.).

23. Department of Neurology, Karamay Central Hospital, China (W.Liang).

24. Department of Neurology, The First Affiliated Hospital of Kunming Medical University, China (Chun Chen).

25. Department of Neurology, Anqing Hospital Affiliated to Anhui Medical University, China (X.S.).

26. Department of Neurology, General Hospital of Wan-bei Coal and Electricity Group, The Third Hospital Affiliated of Bengbu Medical College, Suzhou, China (J.W.).

27. Department of Neurology, Lishui Municipal Central Hospital, China (X.C.).

28. Department of Neurology, Central People’s Hospital of Zhanjiang, Guangdong, China (C.S.).

29. Department of Neurology, Heze Municipal Hospital, China (K.L.).

30. Department of Neurology, The First Affiliated Hospital of Nanchang University, China (P.F.).

31. Department of Neurology, Nanyang Second General Hospital, China (M.W.).

32. Department of Neurosurgical Intervention, Dalian Municipal Central Hospital, China (Z.C.).

33. Department of Neurology, The Second People’s Hospital of Nanning, China (T.L.).

34. Department of Neurology, The First Affiliated Hospital of Medicine Macau University of Technology, Zhuhai, China (G.C.).

35. Department of Neurology, Shanxi Provincial People’s Hospital, Taiyuan, China (Y.S.).

36. Department of Neurology, ORDOS Central Hospital, ORDOS, China (Y.Wu).

37. Department of Neurology, Chengdu Fifth People’s Hospital, China (Y.Wang).

38. Department of Neurosurgery, The Second Affiliated Hospital of Bengbu Medical College, China (H.Z.).

39. Department of Neurosurgery, Tongling People’s Hospital, China (J.C.).

40. Department of Neurology, Taizhou Municipal Hospital, China (X.X.).

41. Department of Neurology, Fuyang People’s Hospital, China (Y.Wang.).

42. Department of Neurology, Taihe County People’s Hospital, China (W.G.).

43. Department of Neurology, Huangshan People’s Hospital, China (C.N.).

44. Department of Neurology, The Second People’s Hospital of Anhui Province, Hefei, China (Changchun Chen).

45. Department of Neurology, Jingjiang People’s Hospital, the Seventh Affiliated Hospital of Yangzhou University, China (Yan Liu).

46. Department of Neurosurgery, Jingzhou First People’s Hospital, China (J.M.).

47. Department of Neurology, Affiliated Hospital of Jinggangshan University, Ji’an, China (Y.Z.).

48. Department of Neurology, Changsha First Hospital, China (Y.Liang).

49. Department of Neurology, Taiyuan Central Hospital, China (C.W.).

50. Lehigh Valley Health Network, Allentown, PA (B.W.B.).

51. UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, PA (R.G.N.).

Abstract

Background: The authors compare the effectiveness and safety of endovascular treatment (EVT) versus best medical management (BMM) in strokes attributable to acute basilar artery occlusion (BAO). Methods: The present analysis was based on the ongoing, prospective, multicenter ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion) trial registry in China. Our analytic sample comprised 2134 patients recruited at 48 sites between 2017 and 2021 and included 462 patients who received BMM and 1672 patients who received EVT. We performed an inversed probability of treatment weighting analysis. Qualifying patients had to present within 24 hours of estimated BAO. The primary clinical outcome was favorable functional outcome (modified Rankin Scale score, 0–3) at 90 days. We also performed a sensitivity analysis with the propensity score matching–based and the instrumental variable–based analysis. Results: In our primary analysis using the inversed probability of treatment weighting–based analysis, there was a significantly higher rate of favorable outcome at 90 days among EVT patients compared with BMM-treated patients (adjusted relative risk, 1.42 [95% CI, 1.19–1.65]; absolute risk difference, 11.8% [95% CI, 6.9–16.7]). The mortality was significantly lower (adjusted relative risk, 0.78 [95% CI, 0.69–0.88]; absolute risk difference, −10.3% [95% CI, −15.8 to −4.9]) in patients undergoing EVT. Results were generally consistent across the secondary end points. Similar associations were seen in the propensity score matching–based and instrumental variable–based analysis. Conclusions: In this real-world study, EVT was associated with significantly better functional outcomes and survival at 90 days. Well-designed randomized studies comparing EVT with BMM in the acute BAO are needed. Registration: URL: www.chictr.org.cn ; Unique identifier: ChiCTR2000041117.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference43 articles.

1. Basilar artery occlusion

2. Significance of Large Vessel Intracranial Occlusion Causing Acute Ischemic Stroke and TIA

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5. Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysis

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