Outcomes of Endovascular Therapy in Acute Basilar Artery Occlusion

Dec 21, 2021
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Authors:
Kong W, Yuan J, Huang J, et al.
Citation:
Outcomes of Endovascular Therapy in Acute Basilar Artery Occlusion With Severe Symptoms. JAMA Netw Open 2021;4:e2139550.
Summary By:
Mollie McDermott, MD, MS

Quick Takes

  • A recent observational study of 269 patients with basilar artery occlusion suggested that endovascular therapy (EVT) may be safer and more effective for patients with mild symptoms (NIHSS ≤6) than for patients with more severe symptoms.
  • The current observational study seeks to compare the outcomes of patients with basilar artery occlusion and severe stroke (NIH stroke scale score ≥21) who are treated with EVT versus standard medical therapy (SMT).
  • In this study, after adjustment for potential prognostic factors, patients who were treated with EVT had better functional outcomes and lower mortality than those treated with SMT.
  • The observational nature of this study precludes assumptions about causality but is at least encouraging toward EVT for patients with basilar artery occlusion and severe symptoms.

Study Questions:

Compared to standard medical therapy (SMT), is endovascular therapy (EVT) associated with better outcomes among patients with acute basilar artery occlusion and severe symptoms?

Methods:

This is a substudy of a registry of 829 consecutive patients with acute basilar artery occlusion treated at one of 47 stroke centers in China. Stroke severity was dichotomized as severe (National Institutes of Health Stroke Scale [NIHSS] score ≥21) or minor to moderate (<21). Of the 829 total patients, 542 patients had severe stroke and were included in this analysis. The primary outcome was modified Rankin scale (mRS) score (ranging from 0 [no symptoms] to 6 [death]) at 90 days. Adjustment was made for the following factors: age, sex, baseline systolic blood pressure, smoking history, atrial fibrillation status, baseline NIHSS score, imaging scores, stroke etiology, occlusion site, intravenous thrombolysis receipt, and onset to treatment time.

Results:

Of the 542 included patients, 147 (27.1%) were women and 395 (72.9%) were men. Among the 542 patients, 431 patients (79.5%) received EVT and 111 patients (20.5%) received SMT. Treatment with EVT compared to SMT was associated with a more favorable median 90-day mRS (adjusted odds ratio [aOR], 3.44; 95% confidence interval [CI], 2.05-5.78). Incidence of any intracranial hemorrhage was higher in the EVT group than in the SMT group (aOR, 17.04; 95% CI, 2.28-127.55), but 90-day mortality was lower (aOR, 0.27; 95% CI, 0.15-0.50).

Conclusions:

In this observational study of patients with severe stroke and acute basilar artery occlusion, treatment with EVT was associated with better 90-day outcomes than treatment with standard medical therapy.

Perspective:

This study is encouraging toward EVT for patients with basilar artery occlusion and severe symptoms. However, because this is an observational study and vulnerable to selection bias, the results should be interpreted with caution. Patients who stood a poor chance of a good outcome, as perceived by the treating team, may have been managed with SMT in preference to EVT, the latter being the more resource-intensive option. A randomized controlled trial would be required to confidently answer the question of which treatment is superior for this patient population.

Clinical Topics: Arrhythmias and Clinical EP, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Atrial Fibrillation, Basilar Artery, Blood Pressure, Coronary Occlusion, Endovascular Procedures, Secondary Prevention, Stroke, Thrombolytic Therapy, Vascular Diseases


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