急性基底动脉闭塞血管内治疗中卒中病因的影响：ATTENTION 随机试验的事后分析。

Effect of Stroke Etiology on Endovascular Treatment for Acute Basilar-Artery Occlusion: A Post Hoc Analysis of the ATTENTION Randomized Trial.

机构信息

Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.).

Department of Neurology and Radiology, Boston Medical Center, MA (T.N.N.).

出版信息

Stroke. 2024 Aug;55(8):1973-1981. doi: 10.1161/STROKEAHA.124.047568. Epub 2024 Jul 22.

DOI:10.1161/STROKEAHA.124.047568

PMID:39038096

Abstract

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 =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.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT04751708.

摘要

背景

卒中病因可能会影响基底动脉闭塞（BAO）患者的结局。本研究旨在评估不同卒中病因的急性 BAO 患者接受最佳药物治疗（BMT）加血管内治疗（EVT）与单纯 BMT 治疗的疗效和安全性差异。

方法

本研究是 ATTENTION 试验（急性基底动脉闭塞血管内治疗试验）的事后分析，该试验是 2021 年 2 月至 2022 年 9 月在中国 36 个中心进行的一项多中心、随机试验。根据卒中病因（大动脉粥样硬化[LAA]、心源性栓塞和未确定原因/其他确定原因[UC/ODC]），将急性 BAO 患者分为 3 组。主要结局为 90 天时的良好结局（改良Rankin 量表评分 0-3）。安全性结局包括症状性颅内出血和 90 天死亡率。

结果

共纳入 340 例 BAO 患者，其中 150 例（44.1%）为 LAA，72 例（21.2%）为心源性栓塞，118 例（34.7%）为 UC/ODC。分别接受 BMT 加 EVT 和 BMT 治疗的患者，90 天时的良好结局率分别为 LAA 组 49.1%和 23.8%（优势比，3.08[95%CI，1.38-6.89]）；心源性栓塞组为 52.2%和 30.8%（优势比，2.45[95%CI，0.89-6.77]）；UC/ODC 组为 37.5%和 17.4%（优势比，2.85[95%CI，1.16-7.01]），卒中病因与治疗的交互作用检验值为=0.89。LAA、心源性栓塞和 UC/ODC 接受 EVT 治疗的患者症状性颅内出血发生率分别为 8.3%、2.2%和 3.2%，而接受 BMT 治疗的患者无一例发生。与单纯 BMT 治疗相比，EVT 治疗患者 90 天死亡率较低。