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Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: Results From the ATTENTION Multicenter Registry.
Tao, Chunrong; Qureshi, Adnan I; Yin, Yamei; Li, Jie; Li, Rui; Xu, Pengfei; Sun, Jun; Liao, Geng; Yue, Xincan; Shi, Hongchao; Liu, Yongchang; Ma, Zhengfei; Zhang, Jinhua; Xiao, Guodong; Xu, Bo; Xu, Chenghua; Su, Junfeng; Zhou, Wensheng; Huang, Shuchun; Yang, Weimin; Chen, Hongbing; Li, Wei; Li, Yongkun; Liu, Dezhi; Yu, Chuanqing; Yuan, Guangxiong; Wang, Chaobin; Liang, Wenbao; Chen, Chun; Shi, Xueying; Wang, Junjun; Wu, Yingchun; Cai, Xueli; Shen, Chunyun; Li, Kai; Fang, Pu; Wang, Ming; Chen, Zhongjun; Li, Tong; Cheng, Guangsen; Sun, Yaxuan; Wang, Yan; Zhang, Hui; Chen, Jie; Xu, Xiaohui; Wang, Youmeng; Geng, Wanjie; Ni, Chuyuan; Chen, Changchun; Liu, Yan.
Affiliation
  • Tao C; Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei Anhui, 230001, China (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.).
  • Qureshi AI; Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis (A.I.Q.).
  • Yin Y; Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei Anhui, 230001, China (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.).
  • Li J; Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei Anhui, 230001, China (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.).
  • Li R; Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei Anhui, 230001, China (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.).
  • Xu P; Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei Anhui, 230001, China (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.).
  • Sun J; Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei Anhui, 230001, China (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.).
  • Liao G; Department of Neurology, Maoming People's Hospital, Guangdong, China (G.L.).
  • Yue X; Department of Neurosurgery, Zhoukou Central Hospital, China (X.Y.).
  • Shi H; Department of Neurology, Nanjing First Hospital, China (H.S.).
  • Liu Y; Department of Neurovascular Intervention, Cangzhou Central Hospital, China (Yongchang Liu).
  • Ma Z; Department of Neurology, Suzhou Municipal Hospital, China (Z.M.).
  • Zhang J; Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z.).
  • Xiao G; Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, China (G.X.).
  • Xu B; Department of Neurology, Qingdao Central Hospital, Qingdao University, China (B.X.).
  • Xu C; Department of Neurology, Taizhou First People's Hospital, China (C.X.).
  • Su J; Department of Neurology, Jingzhou Central Hospital, China (J.Su).
  • Zhou W; Department of Neurology, Hunan Provincial People's Hospital, Changsha, China (W.Z.).
  • Huang S; Department of Neurology, Hospital 302 Attached to Guizhou Aviation Group, Guizhou, China (S.H.).
  • Yang W; Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China (W.Y.).
  • Chen H; Department of Neurology and Stroke Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (H.C.).
  • Li W; Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, China (W.Li).
  • Li Y; Department of Neurology, Fujian Provincial Hospital, Fuzhou, China (Y.Li).
  • Liu D; Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, China (D.L.).
  • Yu C; Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China (C.Y.).
  • Yuan G; Department of Emergency, Xiangtan Central Hospital, China (G.Y.).
  • Wang C; Department of Neurology, Liangxiang Hospital, Fangshan District, Beijing, China (C.W.).
  • Liang W; Department of Neurology, Karamay Central Hospital, China (W.Liang).
  • Chen C; Department of Neurology, The First Affiliated Hospital of Kunming Medical University, China (Chun Chen).
  • Shi X; Department of Neurology, Anqing Hospital Affiliated to Anhui Medical University, China (X.S.).
  • Wang J; Department of Neurology, General Hospital of Wan-bei Coal and Electricity Group, The Third Hospital Affiliated of Bengbu Medical College, Suzhou, China (J.W.).
  • Wu Y; Department of Neurology, General Hospital of Wan-bei Coal and Electricity Group, The Third Hospital Affiliated of Bengbu Medical College, Suzhou, China (J.W.).
  • Cai X; Department of Neurology, Lishui Municipal Central Hospital, China (X.C.).
  • Shen C; Department of Neurology, Central People's Hospital of Zhanjiang, Guangdong, China (C.S.).
  • Li K; Department of Neurology, Heze Municipal Hospital, China (K.L.).
  • Fang P; Department of Neurology, The First Affiliated Hospital of Nanchang University, China (P.F.).
  • Wang M; Department of Neurology, Nanyang Second General Hospital, China (M.W.).
  • Chen Z; Department of Neurosurgical Intervention, Dalian Municipal Central Hospital, China (Z.C.).
  • Li T; Department of Neurology, The Second People's Hospital of Nanning, China (T.L.).
  • Cheng G; Department of Neurology, The First Affiliated Hospital of Medicine Macau University of Technology, Zhuhai, China (G.C.).
  • Sun Y; Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China (Y.S.).
  • Wang Y; Department of Neurology, ORDOS Central Hospital, ORDOS, China (Y.Wu).
  • Zhang H; Department of Neurology, Chengdu Fifth People's Hospital, China (Y.Wang).
  • Chen J; Department of Neurosurgery, The Second Affiliated Hospital of Bengbu Medical College, China (H.Z.).
  • Xu X; Department of Neurosurgery, Tongling People's Hospital, China (J.C.).
  • Wang Y; Department of Neurology, Taizhou Municipal Hospital, China (X.X.).
  • Geng W; Department of Neurology, Fuyang People's Hospital, China (Y.Wang.).
  • Ni C; Department of Neurology, Taihe County People's Hospital, China (W.G.).
  • Chen C; Department of Neurology, Huangshan People's Hospital, China (C.N.).
  • Liu Y; Department of Neurology, The Second People's Hospital of Anhui Province, Hefei, China (Changchun Chen).
Circulation ; 146(1): 6-17, 2022 07 05.
Article in En | MEDLINE | ID: mdl-35656816
ABSTRACT

BACKGROUND:

The authors compare the effectiveness and safety of endovascular treatment (EVT) versus best medical management (BMM) in strokes attributable to acute basilar artery occlusion (BAO).

METHODS:

The present analysis was based on the ongoing, prospective, multicenter ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion) trial registry in China. Our analytic sample comprised 2134 patients recruited at 48 sites between 2017 and 2021 and included 462 patients who received BMM and 1672 patients who received EVT. We performed an inversed probability of treatment weighting analysis. Qualifying patients had to present within 24 hours of estimated BAO. The primary clinical outcome was favorable functional outcome (modified Rankin Scale score, 0-3) at 90 days. We also performed a sensitivity analysis with the propensity score matching-based and the instrumental variable-based analysis.

RESULTS:

In our primary analysis using the inversed probability of treatment weighting-based analysis, there was a significantly higher rate of favorable outcome at 90 days among EVT patients compared with BMM-treated patients (adjusted relative risk, 1.42 [95% CI, 1.19-1.65]; absolute risk difference, 11.8% [95% CI, 6.9-16.7]). The mortality was significantly lower (adjusted relative risk, 0.78 [95% CI, 0.69-0.88]; absolute risk difference, -10.3% [95% CI, -15.8 to -4.9]) in patients undergoing EVT. Results were generally consistent across the secondary end points. Similar associations were seen in the propensity score matching-based and instrumental variable-based analysis.

CONCLUSIONS:

In this real-world study, EVT was associated with significantly better functional outcomes and survival at 90 days. Well-designed randomized studies comparing EVT with BMM in the acute BAO are needed. REGISTRATION URL www.chictr.org.cn; Unique identifier ChiCTR2000041117.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Arterial Occlusive Diseases / Stroke / Endovascular Procedures Type of study: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Circulation Year: 2022 Document type: Article
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Arterial Occlusive Diseases / Stroke / Endovascular Procedures Type of study: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Circulation Year: 2022 Document type: Article