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Values of Baseline Posterior Circulation Acute Stroke Prognosis Early Computed Tomography Score for Treatment Decision of Acute Basilar Artery Occlusion.
Sang, Hongfei; Li, Fengli; Yuan, Junjie; Liu, Shuai; Luo, Weidong; Wen, Changming; Zhu, Qiyi; Chen, Wenhuo; Lin, Min; Qi, Li; Zhong, Yaoyi; Wang, Zhen; Ling, Wentong; Shi, Zhonghua; Chen, Huisheng; Liu, Wenhua; Liu, Zhensheng; Yao, Xiaoxi; Xiong, Feng; Zeng, Guoyong; Hu, Xiaogang; Dong, Hui; Mao, An; Yang, Guoqiang; Huang, Jiacheng; Chen, Luming; Gong, Zili; Tao, Jian; Liu, Hansheng; Wu, Deping; Qiu, Zhongming; Yang, Qingwu; Zi, Wenjie; Li, Fangfei.
Affiliation
  • Sang H; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Li F; Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, China (H.S.).
  • Yuan J; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Liu S; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Luo W; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Wen C; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Zhu Q; Department of Neurology, Nanyang Central Hospital, China (C.W.).
  • Chen W; Department of Neurology, Linyi People's Hospital, China (Q.Z.).
  • Lin M; Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, China (W.C.).
  • Qi L; Department of Neurology, The 900th Hospital of The People's Liberation Army, China (M.L.).
  • Zhong Y; Department of Neurology, The 924th Hospital of The People's Liberation Army, China (L.Q.).
  • Wang Z; Department of Neurology, The 909th Hospital of The People's Liberation Army, China (Y.Z.).
  • Ling W; Department of Neurology, Changsha Central Hospital, China (Z.W.).
  • Shi Z; Department of Neurology, Zhongshan People's Hospital, China (W. Ling).
  • Chen H; Department of Neurosurgery (Z.S.), The 904th Hospital of The People's Liberation Army, China.
  • Liu W; Department of Neurology, Northern Theater General Hospital of The People's Liberation Army, China (H.C.).
  • Liu Z; Department of Neurology, Wuhan No. 1 Hospital, China (W. Liu).
  • Yao X; Department of Neurology, The First People's Hospital of Yangzhou, Yangzhou University, China (Z.L.).
  • Xiong F; Department of Neurology, The First People's Hospital of Chenzhou, China (X.Y.).
  • Zeng G; Department of Neurology, Zhuzhou Central Hospital, China (F.X.).
  • Hu X; Department of Neurology, Ganzhou People's Hospital, China (G.Z.).
  • Dong H; Department of Military Patient Management (X.H.), The 904th Hospital of The People's Liberation Army, China.
  • Mao A; Department of Cadre Health Care (H.D.), The 903th Hospital of The People's Liberation Army, China.
  • Yang G; Department of Neurology (A.M., Z.Q.), The 903th Hospital of The People's Liberation Army, China.
  • Huang J; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Chen L; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Gong Z; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Tao J; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Liu H; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Wu D; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Qiu Z; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Yang Q; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
  • Zi W; Department of Neurology (A.M., Z.Q.), The 903th Hospital of The People's Liberation Army, China.
  • Li F; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
Stroke ; 52(3): 811-820, 2021 03.
Article in En | MEDLINE | ID: mdl-33567874
ABSTRACT
BACKGROUND AND

PURPOSE:

This study aimed to analyze the impact of baseline posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS) on the efficacy and safety of endovascular therapy (EVT) for patients with acute basilar artery occlusion.

METHODS:

The BASILAR was a nationwide prospective registry of consecutive patients with a symptomatic and radiologically confirmed acute basilar artery occlusion within 24 hours of symptom onset. We estimated the effect of standard medical therapy alone (SMT group) versus SMT plus EVT (EVT group) for patients with documented pc-ASPECTS on noncontrast CT, both as a categorical (0-4 versus 5-7 versus 8-10) and as a continuous variable. The primary outcomes included favorable functional outcomes (modified Rankin Scale ≤3) at 90 days and mortality within 90 days.

RESULTS:

In total, 823 cases were included 468 with pc-ASPECTS 8 to 10 (SMT 71; EVT 397), 317 with pc-ASPECTS 5 to 7 (SMT 85; EVT 232), and 38 with pc-ASPECTS 0 to 4 (SMT 13; EVT 25). EVT was associated with higher rate of favorable outcomes (adjusted relative risk with 95% CI, 4.35 [1.30-14.48] and 3.20 [1.68-6.09]; respectively) and lower mortality (60.8% versus 77.6%, P=0.005 and 35.0% versus 66.2%, P<0.001; respectively) than SMT in the pc-ASPECTS 5 to 7 and 8 to 10 subgroups. Continuous benefit curves also showed the superior efficacy and safety of EVT over SMT in patients with pc-ASPECTS ≥5. Furthermore, the prognostic effect of onset to puncture time on favorable outcome with EVT was not significant after adjustment for pc-ASPECTS (adjusted odds ratio, 0.98 [95% CI, 0.94-1.02]).

CONCLUSIONS:

Patients of basilar artery occlusion with pc-ASPECTS ≥5 could benefit from EVT. The baseline pc-ASPECTS appears more important for decision making and predicting prognosis than time to EVT. Registration URL http//www.chictr.org.cn. Unique identifier ChiCTR1800014759.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Basilar Artery / Tomography, X-Ray Computed / Stroke Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Humans / Middle aged Language: En Journal: Stroke Year: 2021 Document type: Article
Fulltext
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Basilar Artery / Tomography, X-Ray Computed / Stroke Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Humans / Middle aged Language: En Journal: Stroke Year: 2021 Document type: Article