Endovascular Treatment Versus Medical Management for Basilar Artery Occlusion with Low-to-Moderate Symptoms (National Institutes of Health Stroke Scale<10)
Cyril Dargazanli1, Isabelle Mourand1, Laurence Poirier2, Julien Labreuche3, David Weisenburger-Lile4, Sébastien Richard5, Célina Ducroux2, Gauthier Marnat6, Romain Bourcier6, Maud Guillen7, François Eugene7, Gregory Walker8, Ronda Lun9, Dariush Dowlatshahi10, Michel Shamy11, Bertrand Lapergue4, Adrien Guenego12, Robert Fahed2
1Gui de Chauliac Hospital, 2The Ottawa Hospital, 3CHU Lille, 4Foch Hospital, 5CHRU-Nancy, 6Centre Hospitalier Universitaire de Bordeaux, 7Centre Hospitalier Universitaire Pontchaillou, 8U of British Columbia, 9tanford Medical Center, 10University of Ottawa, 11Ottawa Hospital - Civic Campus, 12Fondation Rothschild Hospital
Objective:
The purpose of this study was to use data from the large, multicenter Endovascular Treatment in Ischemic Stroke [ETIS] registry to compare 3-month functional outcomes in patients with an acute BAO and low-to-moderate symptoms (NIHSS<10) treated with EVT versus those treated with BMT during the same time period.
Background:
Patients with acute basilar artery occlusion (BAO) and low-to-moderate symptoms (National Institutes of Health Stroke Scale [NIHSS]<10) are poorly represented in thrombectomy trials. Our objective is to compare thrombectomy and best medical management (BMT) in this population.
Design/Methods:
We compared data of all consecutive patients presenting with an initial NIHSS<10 and acute symptomatic BAO included in two registries. The main outcome was the proportion of patients achieving a 3-months favorable outcome (mRS 0-2 or equal to the pre-stroke value). Secondary outcomes included the proportion of patients with an excellent outcome (mRS 0-1 or equal to pre-stroke value), overall mRs distribution (shift analysis) and mortality. Effect sizes for thrombectomy versus BMT alone were calculated using binary or ordinal logistic regression model before after considering confounders using the inverse probability of treatment weighting (IPTW) propensity score method.
Results:
127 patients were included: 64 patients treated with thrombectomy (mean±SD age: 63.4±16.1) and 63 with BMT (mean±SD age: 69.0±14.3). There was no significant difference between groups for the rate of 3 month-favorable outcome or mortality. After propensity-score adjustment, thrombectomy was associated with a significantly higher chance of excellent outcome at 3 months (mRS 0-1 or equal to pre-stroke value) (adjusted OR, 2.68; 95%CI, 1.04 to 6.90; P=0.041).
Conclusions:
Our study suggests that thrombectomy in patients with low-to-moderate symptoms (NIHSS<10) due to BAO does not improve the rate of favorable outcome but could lead to a higher chance of excellent outcome at 3 months.
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