Guangxiong Yuan, Thanh N Nguyen, Lei Liu, Rui Li, Hong Xia, Chen Long, Junxiong Wu, Jun Xu, Feng Huang, Bo He, Derong Wu, Hailing Wang, Can Feng, Yong Liang, Xianghong Zhou, Zhenhua Xiao, Li Luo, Yanjuan Hu, Bin Liu, Weibo Peng, Chao Zhang, Tao Cui, Gaoshan Zhao, Lihua Xu, Gaoting Ma, Wei Hu
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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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 <i>P</i>=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.</p><p><strong>Conclusions: </strong>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. 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引用次数: 0
摘要
背景：卒中病因可能影响基底动脉闭塞（BAO）患者的预后。本研究旨在评估在不同卒中病因的急性基底动脉闭塞症患者中，最佳药物治疗（BMT）加血管内治疗（EVT）与单纯BMT在疗效和安全性方面的差异：本研究是对ATTENTION试验（急性基底动脉闭塞的血管内治疗试验）的事后分析，该试验是一项多中心随机试验，于2021年2月至2022年9月在中国的36个中心进行。根据卒中病因将急性基底动脉闭塞症患者分为三组（大动脉粥样硬化[LAA]、心源性栓塞和病因未定/其他确定病因[UC/ODC]）。主要结果是90天后的良好结果（修改后的Rankin量表评分为0-3分）。安全性结果包括无症状性颅内出血和 90 天死亡率：共纳入了 340 名 BAO 患者，其中 150 人（44.1%）患有 LAA，72 人（21.2%）患有心肌栓塞，118 人（34.7%）患有 UC/ODC。在接受 BMT 加 EVT 和单纯 BMT 治疗的患者中，LAA 组 90 天后的良好预后率分别为 49.1%和 23.8%（几率比 3.08 [95% CI, 1.38-6.89]）；心肌栓塞组分别为 52.2%和 30.8%（几率比 3.08 [95% CI, 1.38-6.89]）。心肌栓塞组分别为52.2%和30.8%（几率比，2.45 [95% CI，0.89-6.77]）；UC/ODC组分别为37.5%和17.4%（几率比，2.85 [95% CI，1.16-7.01]），卒中病因×治疗交互作用的P=0.89。在接受EVT治疗的LAA、心源性栓塞和UC/ODC患者中，无症状性颅内出血的发生率分别为8.3%、2.2%和3.2%，而在接受BMT治疗的患者中，无症状性颅内出血的发生率。在3个病因组中，接受EVT治疗的患者90天死亡率低于单纯BMT治疗的患者：结论：在急性 BAO 患者中，无论心肌栓塞、LAA 或 UC/ODC 的病因如何，EVT 与单纯 BMT 相比可能会带来良好的预后和较低的 90 天死亡率。卒中病因对EVT获益的影响应通过进一步的试验来探讨：URL：https://www.clinicaltrials.gov；唯一标识符：NCT04751708。
Effect of Stroke Etiology on Endovascular Treatment for Acute Basilar-Artery Occlusion: A Post Hoc Analysis of the ATTENTION Randomized Trial.
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.
期刊介绍：
Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery.
The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists.
Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.
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