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Endovascular Treatment vs Medical Management for Basilar Artery Occlusion With Low to Moderate Symptoms
TAKE-HOME MESSAGE
- The largest trials (ATTENTION and BAOCHE) showing the benefit of endovascular thrombectomy (EVT) in patients with basilar artery occlusion only included patients with severe stroke (NIHSS score, >10), and this retrospective, observational, cohort study investigated the outcomes of EVT (versus best medical therapy alone) in patients with basilar artery occlusion leading to mild to moderate symptoms (NIHSS score, <10). In patients undergoing EVT, the median NIHSS score was 6, and the mean age was 63.4 years. Successful reperfusion (TICI score, 2b/3) was achieved in a majority (98.4%) of the patients undergoing EVT after one or two passes. There was no difference in the rates of favorable (modified Rankin Scale [mRS] score, 0–2) and good outcomes (mRS score, 0–3) between the groups. However, excellent outcomes (mRS score, 0–1) was more common in the EVT group, but this group had higher rates of any intracerebral hemorrhage. Additionally, procedural complications were noted in 23.4% of the patients.
- This study failed to show the benefit of EVT in patients with basilar artery occlusion leading to mild to moderate symptoms, which is in line with the results of the previous studies (BASICS) and the current practice.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Patients with acute basilar artery occlusion (BAO) and low-to-moderate symptoms (National Institutes of Health Stroke Scale [NIHSS] < 10) are poorly represented in thrombectomy trials. Our objective is to compare thrombectomy and best medical management (BMT) in this population.
METHODS
We compared data of all consecutive patients presenting with an initial NIHSS < 10 and acute symptomatic BAO included in two registries. The main outcome was the proportion of patients achieving a 3-months favorable outcome (mRS 0-2 or equal to the pre-stroke value). Secondary outcomes included the proportion of patients with an excellent outcome (mRS 0-1 or equal to pre-stroke value), overall mRs distribution (shift analysis) and mortality. Effect sizes for thrombectomy versus BMT alone were calculated using binary or ordinal logistic regression model before after considering confounders using the inverse probability of treatment weighting (IPTW) propensity score method.
RESULTS
One hundred twenty-seven patients were included: sixty-four patients treated with thrombectomy (mean ± SD age: 63.4 ± 16.1) and sixty-three with BMT (mean ± SD age: 69.0 ± 14.3). There was no significant difference between groups for the rate of 3 month-favorable outcome or mortality. 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 value; adjusted OR, 2.68; 95%CI, 1.04-6.90; p = 0.041).
CONCLUSION
Our study suggests that thrombectomy in patients with low-to-moderate symptoms (NIHSS < 10) due to BAO does not improve the rate of favorable outcome but could lead to a higher chance of excellent outcome at 3 months.
Additional Info
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Endovascular treatment versus medical management for basilar artery occlusion with low-to-moderate symptoms (National Institutes of Health Stroke Scale < 10)
Eur Stroke J 2024 Oct 13;[EPub Ahead of Print], C Dargazanli, I Mourand, M Mahmoudi, L Poirier, J Labreuche, D Weisenburger-Lile, B Gory, S Richard, C Ducroux, M Piotin, R Blanc, L Lucas, G Marnat, M Aubertin, C Arquizan, R Bourcier, L Detraz, S Vannier, M Guillen, F Eugene, G Walker, R Lun, D Dowlatshahi, M Shamy, A Consoli, V Costalat, B Lapergue, B Maïer, A Guenego, R FahedFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.