Endovascular therapy for stroke due to basilar-artery occlusion

Langezaal, L.C.M.; Hoeven, E.J.R.J. van der; Mont'Alverne, F.J.A.; Carvalho, J.J.F. de; Lima, F.O.; Dippel, D.W.J.; ... ; BASICS Study Grp (2021)

Article / Letter to editor

Background The effectiveness of endovascular therapy in patients with stroke caused by basilar-artery occlusion has not been well studied.Methods We randomly assigned patients within 6 hours after the estimated time of onset of a stroke due to basilar-artery occlusion, in a 1:1 ratio, to receive endovascular therapy or standard medical care. The primary outcome was a favorable functional outcome, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 to 6, with 0 indicating no disability, 3 indicating moderate disability, and 6 indicating death) at 90 days. The primary safety outcomes were symptomatic intracranial hemorrhage within 3 days after the initiation of treatment and mortality at 90 days.Results A total of 300 patients were enrolled (154 in the endovascular therapy group and 146 in the medical care group). Intravenous thrombolysis was used in 78.6% of the patients in the endovascular group and in 79.5% of those in the medical group. Endovascular treatment was initiated at a median of 4.4 hours after stroke onset. A favorable functional outcome occurred in 68 of 154 patients (44.2%) in the endovascular group and 55 of 146 patients (37.7%) in the medical care group (risk ratio, 1.18; 95% confidence interval [CI], 0.92 to 1.50). Symptomatic intracranial hemorrhage occurred in 4.5% of the patients after endovascular therapy and in 0.7% of those after medical therapy (risk ratio, 6.9; 95% CI, 0.9 to 53.0); mortality at 90 days was 38.3% and 43.2%, respectively (risk ratio, 0.87; 95% CI, 0.68 to 1.12).Conclusions Among patients with stroke from basilar-artery occlusion, endovascular therapy and medical therapy did not differ significantly with respect to a favorable functional outcome, but, as reflected by the wide confidence interval for the primary outcome, the results of this trial may not exclude a substantial benefit of endovascular therapy. Larger trials are needed to determine the efficacy and safety of endovascular therapy for basilar-artery occlusion. (Funded by the Dutch Heart Foundation and others; BASICS ClinicalTrials.gov number, NCT01717755; Netherlands Trial Register number, NL2500.)Endovascular Therapy for Basilar-Artery Stroke In a randomized trial involving 300 patients with basilar-artery stroke, endovascular thrombectomy was not significantly different from medical therapy with respect to a favorable functional outcome (modified Rankin scale score of 0 to 3) at 90 days, but a clinically significant benefit could not be excluded.

• All authors: Langezaal, L.C.M.; Hoeven, E.J.R.J. van der; Mont'Alverne, F.J.A.; Carvalho, J.J.F. de; Lima, F.O.; Dippel, D.W.J.; Lugt, A. van der; R.T.H. lo; Boiten, J.; Nijeholt, G.J.L.A.; Staals, J.; Zwam, W.H. van; Nederkoorn, P.J.; Majoie, C.B.L.M.; Gerber, J.C.; Mazighi, M.; Piotin, M.; Zini, A.; Vallone, S.; Hofmeijer, J.; Martins, S.O.; Nolte, C.H.; Szabo, K.; Dias, F.A.; Abud, D.G.; Wermer, M.J.H.; Remmers, M.J.M.; Schneider, H.; Rueckert, C.M.; Laat, K.F. de; Yoo, A.J.; Doormaal, P.J. van; Es, A.C.G.M. van; Emmer, B.J.; Michel, P.; Puetz, V.; Audebert, H.J.; Pontes-Neto, O.M.; Vos, J.A.; Kappelle, L.J.; Algra, A.; Schonewille, W.J.; BASICS Study Grp
• Date: 2021-05-20
• Journal: New England Journal of Medicine
• Volume: 384
• Issue: 20
• Pages: 1910 - 1920
• DOI: doi:10.1056/NEJMoa2030297
• Link: https://opus.bibliothek.uni-augsburg.de/opus4/files/87346/87346.pdf