Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Department of Neurology, The 903th Hospital of The People's Liberation Army, Hangzhou, China.
JAMA Neurol. 2020 May 1;77(5):561-573. doi: 10.1001/jamaneurol.2020.0156.
Several randomized clinical trials have recently established the safety and efficacy of endovascular treatment (EVT) of acute ischemic stroke in the anterior circulation. However, it remains uncertain whether patients with acute basilar artery occlusion (BAO) benefit from EVT.
To evaluate the association between EVT and clinical outcomes of patients with acute BAO.
DESIGN, SETTING, AND PARTICIPANTS: This nonrandomized cohort study, the EVT for Acute Basilar Artery Occlusion Study (BASILAR) study, was a nationwide prospective registry of consecutive patients presenting with an acute, symptomatic, radiologically confirmed BAO to 47 comprehensive stroke centers across 15 provinces in China between January 2014 and May 2019. Patients with acute BAO within 24 hours of estimated occlusion time were divided into groups receiving standard medical treatment plus EVT or standard medical treatment alone.
The primary outcome was the improvement in modified Rankin Scale scores (range, 0 to 6 points, with higher scores indicating greater disability) at 90 days across the 2 groups assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. The secondary efficacy outcome was the rate of favorable functional outcomes defined as modified Rankin Scale scores of 3 or less (indicating an ability to walk unassisted) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage and 90-day mortality.
A total of 1254 patients were assessed, and 829 patients (of whom 612 were men [73.8%]; median [interquartile] age, 65 [57-74] years) were recruited into the study. Of these, 647 were treated with standard medical treatment plus EVT and 182 with standard medical treatment alone. Ninety-day functional outcomes were substantially improved by EVT (adjusted common odds ratio, 3.08 [95% CI, 2.09-4.55]; P < .001). Moreover, EVT was associated with a significantly higher rate of 90-day modified Rankin Scale scores of 3 or less (adjusted odds ratio, 4.70 [95% CI, 2.53-8.75]; P < .001) and a lower rate of 90-day mortality (adjusted odds ratio, 2.93 [95% CI, 1.95-4.40]; P < .001) despite an increase in symptomatic intracerebral hemorrhage (45 of 636 patients [7.1%] vs 1 of 182 patients [0.5%]; P < .001).
Among patients with acute BAO, EVT administered within 24 hours of estimated occlusion time is associated with better functional outcomes and reduced mortality.
最近几项随机临床试验已经证实了血管内治疗（EVT）在急性前循环缺血性卒中中的安全性和疗效。然而，急性基底动脉闭塞（BAO）患者是否受益于 EVT 仍不确定。
评估 EVT 与急性 BAO 患者临床结局的相关性。
设计、地点和参与者：这项非随机队列研究，即急性基底动脉闭塞血管内治疗研究（BASILAR），是一项全国性前瞻性登记研究，纳入了 2014 年 1 月至 2019 年 5 月期间，中国 15 个省的 47 家综合卒中中心连续收治的 1254 例急性、症状性、影像学证实的 BAO 患者。将发病 24 小时内的急性 BAO 患者分为接受标准药物治疗+EVT 组或单纯标准药物治疗组。
主要结局是 90 天时两组改良 Rankin 量表（0 至 6 分，得分越高表示残疾程度越严重）评分的改善情况，采用有序逻辑回归移位分析作为共同比值比进行评估，同时调整了预设的预后因素。次要疗效结局是 90 天时改良 Rankin 量表评分为 3 分或以下（表示能够独立行走）的良好功能结局的比例。安全性结局包括症状性颅内出血和 90 天死亡率。
共评估了 1254 例患者，其中 829 例（其中 612 例为男性[73.8%]；中位[四分位数间距]年龄 65[57-74]岁）被纳入研究。其中，647 例接受标准药物治疗+EVT 治疗，182 例接受单纯标准药物治疗。EVT 可显著改善 90 天的功能结局（调整后的共同比值比为 3.08[95%CI，2.09-4.55]；P<0.001）。此外，EVT 还与 90 天改良 Rankin 量表评分为 3 分或以下的比例显著增加（调整后的比值比为 4.70[95%CI，2.53-8.75]；P<0.001）和 90 天死亡率降低（调整后的比值比为 2.93[95%CI，1.95-4.40]）相关，尽管症状性颅内出血增加（636 例患者中有 45 例[7.1%] vs 182 例患者中有 1 例[0.5%]；P<0.001）。
在急性 BAO 患者中，发病 24 小时内进行 EVT 与更好的功能结局和降低死亡率相关。
