Assessment of Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry
Authors: Wenjie Zi, Zhongming Qiu, Deping Wu, Fengli Li, Hansheng Liu, Wenhua Liu, Wenguo Huang, Zhonghua Shi, Yongjie Bai, Zhensheng Liu, Li Wang, Shiquan Yang, Jie Pu, Changming Wen, Shouchun Wang, Qiyi Zhu, Wenhuo Chen, Congguo Yin, Min Lin, Li Qi, Yaoyi Zhong, Zhen Wang, Wenjun Wu, Huisheng Chen, Xiaoxi Yao, Feng Xiong, Guoyong Zeng, Zhiming Zhou, Zhilin Wu, Yue Wan, Huiyuan Peng, Bing Li, Xinping Hu, Hongbin Wen, Wangtao Zhong, Leyuan Wang, Ping Jin, Fuqiang Guo, Ju Han, Xinmin Fu, Zhibing Ai, Xiguang Tian, Xiaoya Feng, Bo Sun, Zhizhi Huang, Wei Li, Peiyang Zhou, Mingyi Tu, Xiangrong Sun, Hua Li, Wencheng He, Tao Qiu, Zhengzhou Yuan, Chengsong Yue, Jun Yang, Weidong Luo, Zili Gong, Jie Shuai, Raul Gomes Nogueira, Qingwu Yang
Journal: JAMA Neurology (2020)

<h3>Importance</h3> Several randomized clinical trials have recently established the safety and efficacy of endovascular treatment (EVT) of acute ischemic stroke in the anterior circulation. However, it remains uncertain whether patients with acute basilar artery occlusion (BAO) benefit from EVT. <h3>Objective</h3> To evaluate the association between EVT and clinical outcomes of patients with acute BAO. <h3>Design, Setting, and Participants</h3> This nonrandomized cohort study, the EVT for Acute Basilar Artery Occlusion Study (BASILAR) study, was a nationwide prospective registry of consecutive patients presenting with an acute, symptomatic, radiologically confirmed BAO to 47 comprehensive stroke centers across 15 provinces in China between January 2014 and May 2019. Patients with acute BAO within 24 hours of estimated occlusion time were divided into groups receiving standard medical treatment plus EVT or standard medical treatment alone. <h3>Main Outcomes and Measures</h3> The primary outcome was the improvement in modified Rankin Scale scores (range, 0 to 6 points, with higher scores indicating greater disability) at 90 days across the 2 groups assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. The secondary efficacy outcome was the rate of favorable functional outcomes defined as modified Rankin Scale scores of 3 or less (indicating an ability to walk unassisted) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage and 90-day mortality. <h3>Results</h3> A total of 1254 patients were assessed, and 829 patients (of whom 612 were men [73.8%]; median [interquartile] age, 65 [57-74] years) were recruited into the study. Of these, 647 were treated with standard medical treatment plus EVT and 182 with standard medical treatment alone. Ninety-day functional outcomes were substantially improved by EVT (adjusted common odds ratio, 3.08 [95% CI, 2.09-4.55];<i>P</i> &lt; .001). Moreover, EVT was associated with a significantly higher rate of 90-day modified Rankin Scale scores of 3 or less (adjusted odds ratio, 4.70 [95% CI, 2.53-8.75];<i>P</i> &lt; .001) and a lower rate of 90-day mortality (adjusted odds ratio, 2.93 [95% CI, 1.95-4.40];<i>P</i> &lt; .001) despite an increase in symptomatic intracerebral hemorrhage (45 of 636 patients [7.1%] vs 1 of 182 patients [0.5%];<i>P</i> &lt; .001). <h3>Conclusions and Relevance</h3> Among patients with acute BAO, EVT administered within 24 hours of estimated occlusion time is associated with better functional outcomes and reduced mortality.