作者
Chunrong Tao,Adnan I. Qureshi,Yamei Yin,Jie Li,Rui Li,Pengfei Xu,Jun Sun,Geng Liao,Xincan Yue,Hongchao Shi,Yongchang Liu,Zhengfei Ma,Jinhua Zhang,Guodong Xiao,Bo Xu,Chenghua Xu,Junfeng Su,Wensheng Zhou,Shuchun Huang,Weimin Yang,Hongbing Chen,Wei Li,Yongkun Li,Dezhi Liu,Chuanqing Yu,Guangxiong Yuan,Chaobin Wang,Wenbao Liang,Chun Chen,Xueying Shi,Junjun Wang,Yingchun Wu,Xueli Cai,Chunyun Shen,Kai Li,Fang Pu,Ming Wang,Zhongjun Chen,Tong Li,Guangsen Cheng,Yaxuan Sun,Yan Wang,Hui Zhang,Jie Chen,Xiaohui Xu,Youmeng Wang,Wanjie Geng,Chuyuan Ni,Changchun Chen,Liu Yan,Jie Min,Yongcheng Zhang,Yong Liang,Chao Wen,Blaise Baxter,Raul G Nogueira,Wei Hu
摘要
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.