Räty Silja, Strambo Davide, Gomez-Exposito Alexandra, Marto João Pedro, Ramos João Nuno, Krebs Stefan, Virtanen Pekka, Ritvonen Juhani, Abdalkader Mohamad, Klein Piers, Sairanen Tiina, Sykora Marek, Lindsberg Perttu J, Poli Sven, Michel Patrik, Nguyen Thanh N, Strbian Daniel
Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.
Int J Stroke. 2025 May 12:17474930251344451. doi: 10.1177/17474930251344451.
Randomized controlled trials have demonstrated an improved outcome of basilar artery occlusion (BAO) with endovascular thrombectomy (EVT) compared to best medical treatment. However, a minority of the patients recruited up to 12-24 h from onset in the positive trials received intravenous thrombolysis (IVT), and a trial with a higher IVT rate did not show superiority of EVT. Thus, the efficacy and safety of EVT compared to IVT for BAO remain less clear.
We aimed to compare outcomes after IVT alone to EVT with or without IVT for acute BAO.
This international, observational, retrospective study included patients who received recanalization therapy for BAO at six centers between January 2010 and March 2024. The primary outcome was 3-month modified Rankin Scale (mRS) score 0-3, and secondary outcomes comprised mRS 0-2, ordinal mRS, mortality, and symptomatic intracranial hemorrhage. Outcomes after IVT versus EVT ± IVT were compared using inverse probability-weighted regression adjustment models adjusting for known predictors of outcome in BAO and baseline variables differing between the treatment groups. Interaction of the treatment group with symptom severity and onset-to-treatment time was tested.
Of 523 patients with BAO (median age 69, 35.2% women), 28.9% received IVT and 71.1% EVT ± IVT. The IVT-alone group had a lower baseline National Institutes of Health Stroke Scale score (median 11 vs 15) but equally extensive ischemic changes in baseline imaging. After inverse probability-weighted regression adjustment, the IVT-alone group had higher odds of mRS 0-3 (adjusted odds ratio (aOR) = 2.33 [95% confidence interval (CI) = 1.31-4.12]), mRS 0-2 (aOR = 1.93 [95% CI = 1.12-3.30]), lower median mRS (aOR = 1.81 [95% CI = 1.21-2.71]), and lower mortality (aOR = 0.53 [95% CI = 0.29-0.97]), but no difference in symptomatic intracranial hemorrhage (aOR = 0.81 [95% CI = 0.28-2.36]). No interactions for the primary outcome were found.
In this study, patients with BAO had better outcome after IVT than EVT ± IVT independent of symptom severity and time from onset. Although the non-randomized design of the study warrants caution, the results encourage further trials comparing EVT and IVT to guide recanalization therapy in BAO patients.Data access statement:Anonymized data are available upon reasonable request to the corresponding author following the national legislation.
随机对照试验表明，与最佳药物治疗相比，血管内血栓切除术（EVT）可改善基底动脉闭塞（BAO）的预后。然而，在阳性试验中，少数发病12 - 24小时内入组的患者接受了静脉溶栓治疗（IVT），而一项IVT率更高的试验并未显示出EVT的优越性。因此，与IVT相比，EVT治疗BAO的疗效和安全性仍不太明确。
我们旨在比较单纯IVT与联合或不联合IVT的EVT治疗急性BAO后的预后。
这项国际、观察性、回顾性研究纳入了2010年1月至2024年3月期间在六个中心接受BAO再通治疗的患者。主要结局是3个月改良Rankin量表（mRS）评分为0 - 3分，次要结局包括mRS 0 - 2分、mRS序数、死亡率和症状性颅内出血。使用逆概率加权回归调整模型比较IVT与EVT±IVT后的结局，该模型针对BAO结局的已知预测因素以及治疗组之间不同的基线变量进行了调整。检验了治疗组与症状严重程度及发病至治疗时间的交互作用。
在523例BAO患者（中位年龄69岁，35.2%为女性）中，28.9%接受了IVT，71.1%接受了EVT±IVT。单纯IVT组的基线美国国立卫生研究院卒中量表评分较低（中位11分对15分），但基线影像学上的缺血性改变程度相同。经过逆概率加权回归调整后，单纯IVT组mRS 0 - 3的比值比更高（调整后的比值比（aOR） = 2.33 [95%置信区间（CI） = 1.31 - 4.12]），mRS 0 - 2的比值比更高（aOR = 1.93 [95% CI = 1.12 - 3.30]），中位mRS更低（aOR = 1.81 [95% CI = 1.21 - 2.71]），死亡率更低（aOR = 0.53 [95% CI = 0.29 - 0.97]），但症状性颅内出血无差异（aOR = 0.81 [95% CI = 0.28 - 2.36]）。未发现主要结局的交互作用。
在本研究中，BAO患者接受IVT后的预后优于接受EVT±IVT，且与症状严重程度和发病时间无关。尽管本研究的非随机设计需要谨慎对待，但结果鼓励进一步开展比较EVT和IVT的试验，以指导BAO患者的再通治疗。
按照国家法律，在合理请求下，可向通讯作者获取匿名数据。
