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Effect of Stroke Etiology on Endovascular Treatment for Acute Basilar-Artery Occlusion: A Post Hoc Analysis of the ATTENTION Randomized Trial.
Yuan, Guangxiong; Nguyen, Thanh N; Liu, Lei; Li, Rui; Xia, Hong; Long, Chen; Wu, Junxiong; Xu, Jun; Huang, Feng; He, Bo; Wu, Derong; Wang, Hailing; Feng, Can; Liang, Yong; Zhou, Xianghong; Xiao, Zhenhua; Luo, Li; Hu, Yanjuan; Liu, Bin; Peng, Weibo; Zhang, Chao; Cui, Tao; Zhao, Gaoshan; Xu, Lihua; Ma, Gaoting; Hu, Wei.
Afiliación
  • Yuan G; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Nguyen TN; Department of Neurology and Radiology, Boston Medical Center, MA (T.N.N.).
  • Liu L; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Li R; Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China (R.L., C.Z., W.H.).
  • Xia H; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Long C; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Wu J; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Xu J; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Huang F; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • He B; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Wu D; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Wang H; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Feng C; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Liang Y; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Zhou X; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Xiao Z; Department of Emergency, Shaoshan People's Hospital, China (Z.X.).
  • Luo L; Department of Head and Neck Surgery, Xiangtan Central Hospital, China (L. Luo).
  • Hu Y; Department of Emergency, The First People's Hospital of Xiangtan, China (Y.H.).
  • Liu B; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Peng W; Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).
  • Zhang C; Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China (R.L., C.Z., W.H.).
  • Cui T; Department of Neurology, Taihe Country People's Hospital, Linquan, China (T.C.).
  • Zhao G; Department of Neurology, Linquan Country People's Hospital, China (G.Z.).
  • Xu L; Department of Neurology, Jiamusi Central Hospital, China (L.X.).
  • Ma G; Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (G.M.).
  • Hu W; Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China (R.L., C.Z., W.H.).
Stroke ; 55(8): 1973-1981, 2024 Aug.
Article en En | MEDLINE | ID: mdl-39038096
ABSTRACT

BACKGROUND:

Stroke etiology could influence the outcomes in patients with basilar-artery occlusion (BAO). This study aimed to evaluate the differences in efficacy and safety of best medical treatment (BMT) plus endovascular treatment (EVT) versus BMT alone in acute BAO across different stroke etiologies.

METHODS:

The study was a post hoc analysis of the ATTENTION trial (Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion), which was a multicenter, randomized trial at 36 centers in China from February 2021 to September 2022. Patients with acute BAO were classified into 3 groups according to stroke etiology (large-artery atherosclerosis [LAA], cardioembolism, and undetermined cause/other determined cause [UC/ODC]). The primary outcome was a favorable outcome (modified Rankin Scale score of 0-3) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 90-day mortality.

RESULTS:

A total of 340 patients with BAO were included, 150 (44.1%) had LAA, 72 (21.2%) had cardioembolism, and 118 (34.7%) had UC/ODC. For patients treated with BMT plus EVT and BMT alone, respectively, the rate of favorable outcome at 90 days was 49.1% and 23.8% in the LAA group (odds ratio, 3.08 [95% CI, 1.38-6.89]); 52.2% and 30.8% in the cardioembolism group (odds ratio, 2.45 [95% CI, 0.89-6.77]); and 37.5% and 17.4% in the UC/ODC group (odds ratio, 2.85 [95% CI, 1.16-7.01]), with P=0.89 for the stroke etiology×treatment interaction. The rate of symptomatic intracranial hemorrhage in EVT-treated patients with LAA, cardioembolism, and UC/ODC was 8.3%, 2.2%, and 3.2%, respectively, and none of the BMT-treated patients. Lower 90-day mortality was observed in patients with EVT compared with BMT alone across 3 etiology groups.

CONCLUSIONS:

Among patients with acute BAO, EVT compared with BMT alone might be associated with favorable outcomes and lower 90-day mortality, regardless of cardioembolism, LAA, or UC/ODC etiologies. The influence of stroke etiology on the benefit of EVT should be explored by further trials. REGISTRATION URL https//www.clinicaltrials.gov; Unique identifier NCT04751708.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia Vertebrobasilar / Procedimientos Endovasculares Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: Stroke Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia Vertebrobasilar / Procedimientos Endovasculares Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: Stroke Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos