EVT improves functional outcomes in Chinese patients with BAO

In patients with basilar-artery occlusion (BAO), endovascular thrombectomy (EVT) within 12 hours after stroke onset led to better functional outcomes at 90 days than best medical management (BMM) alone, the results of the Chinese ATTENTION trial showed. EVT was associated with procedural complications and intracerebral haemorrhage.

“Despite the overwhelming benefit of EVT for treating anterior circulation large vessel occlusions, it remains unknown whether EVT is beneficial for acute BAO,” introduced study presenter Prof. Raul Nogueira (Grady Memorial Hospital, GA, USA). In the multicentre, prospective, randomised, controlled ATTENTION trial (NCT04751708) of EVT for BAO, 36 comprehensive centres in China participated [1]. The study evaluated the hypothesis that EVT is superior to best medical management (BMM) alone in achieving more favourable outcomes at 90 days in participants with acute BAO stroke within 12 hours from the estimated time of BAO.

The intention-to-treat population consisted of 340 participants, of whom 226 were assigned to the EVT and 114 to the BMM group. The primary outcome was good functional status as per score of 0 to 3 on the modified Rankin scale (mRS) after 90 days.

One-third of the participants received intravenous thrombolysis: 31% in the EVT group and 34% in the control group. The primary endpoint was met by 104 participants (46%) in the EVT group and by 26 (23%) in the control group (adjusted relative risk [aRR] 2.06), with a number needed to treat of 4 (see Figure). Symptomatic intracranial haemorrhage occurred in 12 participants (5%) in the EVT and none in the control arm. Results for the secondary clinical and imaging endpoints largely went in the same direction as those for the primary outcome.

Figure: Modified Rankin Scale after 90 days. A score of 0 to 3 was defined as good functional status [1]



EVT, endovascular thrombectomy; BMM, best medical management; NNT, number-needed-to-treat; CI, confidence interval.

In the EVT and the control group, 31 (13.7%) and 2 (1.8%) of participants, respectively, experienced an asymptomatic intracranial haemorrhage (ICH) at 24–72 hours; 12 (5.3%) and 0 had a symptomatic ICH, per EVT and control group, respectively. At 90 days, 83 (36.7%) participants in the EVT and 63 (55.3%) in the control arm presented with an asymptomatic ICH (adRR 0.66; 95% CI 0.52–0.82). Procedural complications occurred in 15% of the participants in the EVT-receiving group.

As Prof. Nogueira pointed out, Asians have relatively high rates of intracranial atherosclerotic disease, which limits the extent to which these findings can be generalised to Western patients. He added that the overall results of the ATTENTION trial are consistent with modern-era observational studies, large registries, and meta-analyses. The reduction in disability associated with EVT in BAO appears to be within the range of benefits observed in the anterior circulation.

1. Nogueira RG. Endovascular Treatment for Acute Basilar Artery Occlusion: A multicenter Randomized Controlled Trial (ATTENTION). PL5.006, AAN 2023 Annual Meeting, 22–27 April, Boston, USA.

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Posted on 26 June 202328 March 2024