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