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EVT improves functional outcomes in Chinese patients with BAO

Presented By
Dr Raul Nogueira, Grady Memorial Hospital, GA, USA
AAN 2023

In patients with basilar-artery occlusion (BAO), endovascular thrombectomy (EVT) within 12 hours after stroke onset led to better functional outcomes at 90 days compared with best medical management (BMM) alone, the results of the Chinese ATTENTION trial show. 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,” said study presenter Dr Raul Nogueira (Grady Memorial Hospital, GA, USA). For the current multicenter, prospective, randomised, controlled ATTENTION trial (NCT04751708) of EVT for BAO, 36 comprehensive centres in China participated [1]. The study objective was to evaluate the hypothesis that EVT is superior to best medical management (BMM) alone in achieving more favourable outcomes at 90 days in participants presenting 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 thrombectomy group and 114 to the BMM group. The primary outcome was good functional status, defined as a 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 thrombectomy group and 34% in the control group. The primary endpoint was met by 104 patients (46%) in the thrombectomy group and by 26 (23%) in the control group (adjusted relative risk [RR] 2.06; 95% CI 1.46–.91, P<0.001), with a number needed to treat of 4. The risk difference was 23.2% (13.15, 33,3%; P<0.001). Symptomatic intracranial haemorrhage occurred in 12 patients (5%) in the thrombectomy group and none in the control group. Results for the secondary clinical and imaging outcomes largely went in the same direction as those for the primary outcome.

In the EVT and the control group, 31 (13.7%) and 2 (1.8%) of participants, respectively, had an asymptomatic intracranial haemorrhage (ICH) at 24–72 hours; 12 (5.3%) and 0 had a symptomatic ICH, respectively per EVT and control group. At 90 days, 83 (36,7%) in the EVT and 63 (55.3%) in the control group presented with an asymptomatic ICH (adjusted RR, 0.66; 0.52–0.82). Procedural complications occurred in 15% of the participants in the thrombectomy group.

As Dr 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). Session PL5.006, AAN 2023 Annual Meeting, 22–27 April, Boston, USA.


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