Endovascular vs Medical Management of Acute Basilar Artery Occlusion
Authors: Li Rui , Tao Chunrong , Sun Jun , Zhang Chao , Xu Pengfei , Yin Yamei , Han Hongxing , Yuan Guangxiong , Cui Tao , Zhou Peiyang , Chen Wenhuo , Zeng Guoyong , Li Yuwen , Ma Zhengfei , Yu Chuanqing , Su Junfeng , Zhou Zhiming , Chen Zhongjun , Wang Li , Luo Cong , Jing Xiaozhong , Wang Anmo , Shen Nan , Abdalkader Mohamad , Nguyen Thanh N. , Qureshi Adnan I. , Saver Jeffrey L. , Nogueira Raul G. , Hu Wei ,   ATTENTION Investigators, Han Hongxing , Wen Changming , Xu Hui , Liao Geng , Sun Yaxuan , Zhang Hui , Chen Jie , Yue Xincan , Ma Xiuyao , Xiao GuoDong , Wang Li , Liu Rui , Yang Weimin , Liu Wenhua , Liu Yong , Guo Fuqiang , Cai Xueli , Yin Bo , Li Jinglun , Fang Pu , Shen Chunyun , Ni Chuyuan , Wang Hui , Liu Liang , Li Kai , Wang Hao , Gao Jun , Yi Tingyu , Wang Youmeng , Wang Tao , Shi Xueying , Cao Zhihua , Long Chen , Chen Li , Zhang Chi , Bao Wei , Liu Xinfeng , Qun Sen , Wang Zi , Chen Juan , Chen Lang , Liu Tianlong , Deng Kexue , Yuan Shuya , Zheng Menglong , Wang Guoping , Song Jianlong , Fang Chuanqing , Baxter Blaise W. , Xu Gelin , Yan Xiaoyan , Gao Feng , Jiao Liqun , Ye Ruidong , Zhang Yongwei , Wu Cangjun , Chen Hongbing , Zhang Guang 
Published: August 2024

Importance

In 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.

Objective

To evaluate 1-year clinical outcomes in patients with acute basilar artery occlusion following endovascular thrombectomy vs control.

Design, Setting, and Participants

This 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.

Exposures

Endovascular thrombectomy (thrombectomy group) vs best medical treatment (control group).

Main Outcomes and Measures

The 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.

Results

Among 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 Relevance

Among 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.