• Chunrong Tao, Raul G Nogueira, Yuyou Zhu, Jun Sun, Hongxing Han, Guangxiong Yuan, Changming Wen, Peiyang Zhou, Wenhuo Chen, Guoyong Zeng, Yuwen Li, Zhengfei Ma, Chuanqing Yu, Junfeng Su, Zhiming Zhou, Zhongjun Chen, Geng Liao, Yaxuan Sun, Youquan Ren, Hui Zhang, Jie Chen, Xincan Yue, Guodong Xiao, Li Wang, Rui Liu, Wenhua Liu, Yong Liu, Chao Zhang, Tianlong Liu, Jianlong Song, Rui Li, Pengfei Xu, Yamei Yin, Guoping Wang, Blaise Baxter, Adnan I Qureshi, Xinfeng Liu, Wei Hu, and ATTENTION Investigators.
• From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.).
• N. Engl. J. Med. 2022 Oct 13; 387 (15): 136113721361-1372.

BackgroundData from trials investigating the effects and risks of endovascular thrombectomy for the treatment of stroke due to basilar-artery occlusion are limited.MethodsWe conducted a multicenter, prospective, randomized, controlled trial of endovascular thrombectomy for basilar-artery occlusion at 36 centers in China. Patients were assigned, in a 2:1 ratio, within 12 hours after the estimated time of basilar-artery occlusion to receive endovascular thrombectomy or best medical care (control). The primary outcome was good functional status, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]), at 90 days. Secondary outcomes included a modified Rankin scale score of 0 to 2, distribution across the modified Rankin scale score categories, and quality of life. Safety outcomes included symptomatic intracranial hemorrhage at 24 to 72 hours, 90-day mortality, and procedural complications.ResultsOf the 507 patients who underwent screening, 340 were in the intention-to-treat population, with 226 assigned to the thrombectomy group and 114 to the control group. Intravenous thrombolysis was used in 31% of the patients in the thrombectomy group and in 34% of those in the control group. Good functional status at 90 days occurred in 104 patients (46%) in the thrombectomy group and in 26 (23%) in the control group (adjusted rate ratio, 2.06; 95% confidence interval [CI], 1.46 to 2.91, P<0.001). Symptomatic intracranial hemorrhage occurred in 12 patients (5%) in the thrombectomy group and in none in the control group. Results for the secondary clinical and imaging outcomes were generally in the same direction as those for the primary outcome. Mortality at 90 days was 37% in the thrombectomy group and 55% in the control group (adjusted risk ratio, 0.66; 95% CI, 0.52 to 0.82). Procedural complications occurred in 14% of the patients in the thrombectomy group, including one death due to arterial perforation.ConclusionsIn a trial involving Chinese patients with basilar-artery occlusion, approximately one third of whom received intravenous thrombolysis, endovascular thrombectomy within 12 hours after stroke onset led to better functional outcomes at 90 days than best medical care but was associated with procedural complications and intracerebral hemorrhage. (Funded by the Program for Innovative Research Team of the First Affiliated Hospital of USTC and others; ATTENTION ClinicalTrials.gov number, NCT04751708.).Copyright © 2022 Massachusetts Medical Society.

58 keywords...

hide…