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Endovascular treatment with standard care improved outcomes for basilar artery occlusion

Patients with acute basilar artery occlusion who were administered endovascular treatment within 24 hours of an estimated occlusion time had better functional outcomes and reduced mortality, according to data presented at the International Stroke Conference.

“To our knowledge, the current analysis represents the largest prospective, multicenter registry of consecutive patients presented with acute symptomatic basilar artery occlusion,” Raul Nogueira, MD, professor of neurology, neurosurgery and radiology at Emory University School of Medicine and director of neuroendovascular service and neurocritical care service at the Marcus Stroke and Neuroscience Center at Grady Memorial Hospital in Atlanta, and colleagues wrote in the study simultaneously published in JAMA Neurology. “The importance of our study becomes even more important in the face of the paucity of prospective data comparing the outcomes of standard medical treatment plus endovascular treatment vs. standard medical treatment alone for patients with basilar artery occlusion, as well as the challenges faced to randomization in this patient population.”

Researchers analyzed data from 829 patients (median age, 65 years; 74% men) who presented within 24 hours of acute, symptomatic basilar artery occlusion at 47 stroke centers in China between January 2014 and May 2019.

Patients were categorized based on the treatment they received: standard medical treatment plus endovascular treatment (n = 647) or standard medical treatment alone (n = 182). Endovascular treatments included balloon angioplasty, stent retrievers and/or thromboaspiration, intra-arterial thrombolysis, stenting or combinations of these approaches. Standard medical treatment was defined as the use of antiplatelet drugs, IV thrombolysis with recombinant tissue plasminogen activator or urokinase, systematic anticoagulation or a combination of treatments.

The primary clinical efficacy outcome was defined as the modified Rankin Scale score at 90 days. Secondary clinical efficacy outcome was the rate of favorable outcomes at 90 days, defined as a modified Rankin Scale score of 3 or less. Safety outcomes were also assessed, defined as symptomatic intracerebral hemorrhage at 48 hours and death within 90 days.

Endovascular treatment substantially improved functional outcomes at 90 days compared with standard medical treatment alone (adjusted common OR = 3.08; 95% CI, 2.09-4.55). This added treatment was also associated with a lower rate of mortality at 90 days (adjusted OR = 2.93; 95% CI, 1.95-4.4) and a higher rate of a modified Rankin Scale score of 3 or less at 90 days (adjusted OR = 4.7; 95% CI, 2.53-8.75).

Patients treated with standard medical treatment and endovascular treatment had a higher rate of symptomatic intracerebral hemorrhage compared with standard medical treatment alone (7.1% vs. 0.5%; P < .001).

“We are looking forward to the results of the two randomized clinical trials, BASICS and BAOCHE, that may have important influence on the management of these patients,” Nogueira and colleagues wrote. – by Darlene Dobkowski

References:

Nogueira R. LB17. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.
Writing Group for the BASILAR Group. JAMA Neurol. 2020;doi:10.1001/jamaneurol.2020.0156.

Disclosures: Nogueira reports relationships with Allm Inc., Brainomix, iSchemaView, Medtronic, Neuravi/Cerenovus, Penumbra, Stryker Neurovascular and Viz.ai. Please see the study for all other authors’ relevant financial disclosures.

Patients with acute basilar artery occlusion who were administered endovascular treatment within 24 hours of an estimated occlusion time had better functional outcomes and reduced mortality, according to data presented at the International Stroke Conference.

“To our knowledge, the current analysis represents the largest prospective, multicenter registry of consecutive patients presented with acute symptomatic basilar artery occlusion,” Raul Nogueira, MD, professor of neurology, neurosurgery and radiology at Emory University School of Medicine and director of neuroendovascular service and neurocritical care service at the Marcus Stroke and Neuroscience Center at Grady Memorial Hospital in Atlanta, and colleagues wrote in the study simultaneously published in JAMA Neurology. “The importance of our study becomes even more important in the face of the paucity of prospective data comparing the outcomes of standard medical treatment plus endovascular treatment vs. standard medical treatment alone for patients with basilar artery occlusion, as well as the challenges faced to randomization in this patient population.”

Researchers analyzed data from 829 patients (median age, 65 years; 74% men) who presented within 24 hours of acute, symptomatic basilar artery occlusion at 47 stroke centers in China between January 2014 and May 2019.

Patients were categorized based on the treatment they received: standard medical treatment plus endovascular treatment (n = 647) or standard medical treatment alone (n = 182). Endovascular treatments included balloon angioplasty, stent retrievers and/or thromboaspiration, intra-arterial thrombolysis, stenting or combinations of these approaches. Standard medical treatment was defined as the use of antiplatelet drugs, IV thrombolysis with recombinant tissue plasminogen activator or urokinase, systematic anticoagulation or a combination of treatments.

The primary clinical efficacy outcome was defined as the modified Rankin Scale score at 90 days. Secondary clinical efficacy outcome was the rate of favorable outcomes at 90 days, defined as a modified Rankin Scale score of 3 or less. Safety outcomes were also assessed, defined as symptomatic intracerebral hemorrhage at 48 hours and death within 90 days.

Endovascular treatment substantially improved functional outcomes at 90 days compared with standard medical treatment alone (adjusted common OR = 3.08; 95% CI, 2.09-4.55). This added treatment was also associated with a lower rate of mortality at 90 days (adjusted OR = 2.93; 95% CI, 1.95-4.4) and a higher rate of a modified Rankin Scale score of 3 or less at 90 days (adjusted OR = 4.7; 95% CI, 2.53-8.75).

Patients treated with standard medical treatment and endovascular treatment had a higher rate of symptomatic intracerebral hemorrhage compared with standard medical treatment alone (7.1% vs. 0.5%; P < .001).

“We are looking forward to the results of the two randomized clinical trials, BASICS and BAOCHE, that may have important influence on the management of these patients,” Nogueira and colleagues wrote. – by Darlene Dobkowski

References:

Nogueira R. LB17. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.
Writing Group for the BASILAR Group. JAMA Neurol. 2020;doi:10.1001/jamaneurol.2020.0156.

Disclosures: Nogueira reports relationships with Allm Inc., Brainomix, iSchemaView, Medtronic, Neuravi/Cerenovus, Penumbra, Stryker Neurovascular and Viz.ai. Please see the study for all other authors’ relevant financial disclosures.

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