Assessment of Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry.,JAMA Neurology

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Assessment of Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry.
JAMA Neurology ( IF 29.0 ) Pub Date : 2020-05-01 , DOI: 10.1001/jamaneurol.2020.0156
, Wenjie Zi ₁ , Zhongming Qiu _{1,

2} , Deping Wu ₁ , Fengli Li ₁ , Hansheng Liu ₁ , Wenhua Liu ₃ , Wenguo Huang ₄ , Zhonghua Shi ₅ , Yongjie Bai ₆ , Zhensheng Liu ₇ , Li Wang ₈ , Shiquan Yang ₉ , Jie Pu ₁₀ , Changming Wen ₁₁ , Shouchun Wang ₁₂ , Qiyi Zhu ₁₃ , Wenhuo Chen ₁₄ , Congguo Yin ₁₅ , Min Lin ₁₆ , Li Qi ₁₇ , Yaoyi Zhong ₁₈ , Zhen Wang ₁₉ , Wenjun Wu ₂₀ , Huisheng Chen ₂₁ , Xiaoxi Yao ₂₂ , Feng Xiong ₂₃ , Guoyong Zeng ₂₄ , Zhiming Zhou ₂₅ , Zhilin Wu ₂₆ , Yue Wan ₂₇ , Huiyuan Peng ₂₈ , Bing Li ₂₉ , Xinping Hu ₃₀ , Hongbin Wen ₃₁ , Wangtao Zhong ₃₂ , Leyuan Wang ₃₃ , Ping Jin ₃₄ , Fuqiang Guo ₃₅ , Ju Han ₃₆ , Xinmin Fu ₃₇ , Zhibing Ai ₃₈ , Xiguang Tian ₃₉ , Xiaoya Feng ₄₀ , Bo Sun ₄₁ , Zhizhi Huang ₄₂ , Wei Li ₄₃ , Peiyang Zhou ₄₄ , Mingyi Tu ₄₅ , Xiangrong Sun ₄₆ , Hua Li ₄₇ , Wencheng He ₄₈ , Tao Qiu _{1,

49} , Zhengzhou Yuan _{1,

50} , Chengsong Yue ₁ , Jun Yang ₁ , Weidong Luo ₁ , Zili Gong ₁ , Jie Shuai ₁ , Raul Gomes Nogueira ₅₁ , Qingwu Yang ₁

Affiliation

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.
Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China.
Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China.
Department of Neurosurgery, The 904th Hospital of The People's Liberation Army, Wuxi, China.
Department of Neurology, The First Affiliated Hospital of Henan Science and Technology University, Luoyang, China.
Department of Neurology, The First People's Hospital of Yangzhou, Yangzhou University, Yangzhou, China.
Department of Neurology, The Third People's Hospital of Zigong, Zigong, China.
Department of Neurology, The 902th Hospital of The People's Liberation Army, Bengbu, China.
Department of Neurology, Hubei Province People's Hospital, Wuhan, China.
Department of Neurology, Nanyang Central Hospital, Nanyang, China.
Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China.
Department of Neurology, Linyi People's Hospital, Linyi, China.
Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China.
Department of Neurology, The First People's Hospital of Hangzhou, Zhejiang University School of Medicine, Hangzhou, China.
Department of Neurology, The 900th Hospital of The People's Liberation Army, Fuzhou, China.
Department of Neurology, The 924th Hospital of The People's Liberation Army, Guilin, China.
Department of Neurology, The 909th Hospital of The People's Liberation Army, Zhangzhou, China.
Department of Neurology, Changsha Central Hospital, Changsha, China.
Department of Neurology, Zhongshan People's Hospital, Zhongshan, China.
Department of Neurology, Northern Theater General Hospital of The People's Liberation Army, Shenyang, China.
Department of Neurology, The First People's Hospital of Chenzhou, Chenzhou, China.
Department of Neurology, Zhuzhou Central Hospital, ZhuZhou, China.
Department of Neurology, Ganzhou People's Hospital, Ganzhou, China.
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China.
Department of Neurology, Yunfu People's Hospital, Yunfu, China.
Department of Neurology, Hubei Zhongshan Hospital, Wuhan, China.
Department of Neurology, Chinese Medical Hospital of Zhongshan, Zhongshan, China.
Department of Neurology, Yuhuangding Hospital, Qingdao University, Yantai, China.
Department of Neurology, Jilin Central Hospital, Jilin, China.
Department of Neurology, Xiangyang Central Hospital, Hubei Arts and Science University, Xiangyang, China.
Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
Department of Neurology, Changle People's Hospital, Changle, China.
Department of Neurology, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, China.
Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China.
Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
Department of Neurology, Xuzhou Central Hospital, Xuzhou, China.
Department of Neurology, Taihe Affiliated Hospital of Hubei Medical University, Shiyan, China.
Department of Neurology, The Chinese Armed Police Force Guangdong Armed Police Corps Hospital, Guangzhou, China.
Department of Neurology, The Third Hospital of Shandong Province, Jinan, China.
Department of Neurology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, China.
Department of Neurology, Baise People's Hospital, Baise, China.
Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Neurology, The First People's Hospital of Xiangyang, Hubei Medical University, Xiangyang, China.
Department of Neurology, Hubei Wuchang Hospital, Wuhan, China.
Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Department of Neurology, The 476th Hospital of The People's Liberation Army, Fuzhou, China.
Department of Neurology, Guiping People's Hospital, Guiping, China.
Department of Neurology, The First People's Hospital of Zigong, Zigong, China.
Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia.

Importance 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. Objective 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. Main Outcomes and Measures 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. Results 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). Conclusions and Relevance Among patients with acute BAO, EVT administered within 24 hours of estimated occlusion time is associated with better functional outcomes and reduced mortality.

更新日期：2020-05-01

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