Hu Wei, Nguyen Thanh N, Qureshi Muhammad, Chen Zhongjun, Tao Chunrong, Li Rui, Yi Ting-Yu, Feng Ganghua, Su Junfeng, Cui Tao, Cao Zhihua, Wang Hao, Zeng Guoyong, Yuan Guangxiong, Jing Xiaozhong, Luo Cong, Zhu Yuyou, Qureshi Adnan I, Nogueira Raul G, Liu Xinfeng, Abdalkader Mohamad
Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, MA.
Neurology. 2025 Aug 12;105(3):e213911. doi: 10.1212/WNL.0000000000213911. Epub 2025 Jul 17.
Acute CT perfusion (CTP) or MRI is not widely available or routinely performed across many stroke centers. We aimed to evaluate whether patients with acute basilar artery occlusion (BAO) who are selected by noncontrast CT (NCCT) for endovascular therapy (EVT) have similar outcomes compared with patients who are selected by CTP.
This was a post hoc analysis of individual patient-level data from the ATTENTION and ATTENTION IA trials. Patients with BAO presenting within 24 hours of estimated onset and selected for EVT by NCCT were compared with those selected by CTP. The primary outcome was the 90-day modified Rankin Scale (mRS) score of 0-3. We used inverse probability of treatment weighting (IPTW) to account for confounders.
Of 550 patients with BAO, 406 met eligibility criteria, of whom 274 (67.5%) were selected for EVT by NCCT and 132 (32.5%) were selected by CTP. The median (interquartile range, [IQR]) age was 67 (57-74) years, 70.7% were male, the median (IQR) baseline NIH Stroke Scale score was 23 (14-35), and the median (IQR) posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) was 9 (8-10). The primary outcome was similar in both NCCT and CTP groups (mRS scores 0-3: 48.5% vs 45.5%, = 0.56, respectively). Functional independence at 90 days (mRS scores 0-2: 37.2% vs 33.3%, = 0.44, respectively), symptomatic intracranial hemorrhage (4.5% vs 7.5%, = 0.29), and 90-day mortality (32.1% vs 34.9%, = 0.83) were similar in both groups, respectively. In IPTW analysis, there was no difference in mRS scores 0-3 at 90 days (odds ratio 0.88 [95% CI 0.58-1.32], = 0.53).
In patients with BAO treated with EVT up to the 24-hour time window, there was no difference in clinical or safety outcomes in patients selected by NCCT compared with CT perfusion.
This study provides Class IV evidence that in patients with BAO, selection for EVT using NCCT yields similar clinical and safety outcomes compared with selection for EVT using CT perfusion.
ATTENTION: ClinicalTrials.gov NCT04751708. ATTENTION IA: ClinicalTrials.gov NCT05684172.
急性CT灌注（CTP）或MRI在许多卒中中心尚未广泛应用或常规开展。我们旨在评估通过非增强CT（NCCT）筛选进行血管内治疗（EVT）的急性基底动脉闭塞（BAO）患者与通过CTP筛选的患者相比，预后是否相似。
这是一项对来自ATTENTION和ATTENTION IA试验的个体患者水平数据进行的事后分析。将发病后24小时内出现BAO且通过NCCT筛选进行EVT的患者与通过CTP筛选的患者进行比较。主要结局是90天改良Rankin量表（mRS）评分为0 - 3分。我们使用治疗权重逆概率（IPTW）来处理混杂因素。
在550例BAO患者中，406例符合入选标准，其中274例（67.5%）通过NCCT筛选进行EVT，132例（32.5%）通过CTP筛选。中位（四分位间距，[IQR]）年龄为67（57 - 74）岁，70.7%为男性，中位（IQR）基线美国国立卫生研究院卒中量表评分是23（14 - 35），中位（IQR）后循环急性卒中预后早期CT评分（pc - ASPECTS）为9（8 - 10）。NCCT组和CTP组的主要结局相似（mRS评分0 - 3分：分别为48.5%和45.5%，P = 0.56）。两组90天时的功能独立性（mRS评分0 - 2分：分别为37.2%和33.3%，P = 0.44）、症状性颅内出血（4.5%对7.5%，P = 0.29）和90天死亡率（32.1%对34.9%，P = 0.83）也分别相似。在IPTW分析中，90天时mRS评分0 - 3分无差异（比值比0.88[95%CI 0.58 - 1.32]，P = 0.53）。
在24小时时间窗内接受EVT治疗的BAO患者中，与CT灌注筛选的患者相比，NCCT筛选的患者在临床或安全性结局方面无差异。
本研究提供IV级证据，即在BAO患者中，使用NCCT筛选进行EVT与使用CT灌注筛选进行EVT相比，产生相似的临床和安全性结局。
ATTENTION：ClinicalTrials.gov NCT04751708。ATTENTION IA：ClinicalTrials.gov NCT05684172。
