Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: Results From the ATTENTION Multicenter Registry

Chunrong Tao; Adnan I Qureshi; Yamei Yin; Jie Li; Rui Li; Pengfei Xu; Jun Sun; Geng Liao; Xincan Yue; Hongchao Shi; Yongchang Liu; Zhengfei Ma; Jinhua Zhang; Guodong Xiao; Bo Xu; Chenghua Xu; Junfeng Su; Wensheng Zhou; Shuchun Huang; Weimin Yang; Hongbing Chen; Wei Li; Yongkun Li; Dezhi Liu; Chuanqing Yu; Guangxiong Yuan; Chaobin Wang; Wenbao Liang; Chun Chen; Xueying Shi; Junjun Wang; Yingchun Wu; Xueli Cai; Chunyun Shen; Kai Li; Pu Fang; Ming Wang; Zhongjun Chen; Tong Li; Guangsen Cheng; Yaxuan Sun; Yan Wang; Hui Zhang; Jie Chen; Xiaohui Xu; Youmeng Wang; Wanjie Geng; Chuyuan Ni; Changchun Chen; Yan Liu; Jie Min; Yongcheng Zhang; Yong Liang; Chao Wen; Blaise W Baxter; Raul G Nogueira; Wei Hu; ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion) Trial Investigators

doi:10.1161/CIRCULATIONAHA.121.058544

Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: Results From the ATTENTION Multicenter Registry

Circulation. 2022 Jul 5;146(1):6-17. doi: 10.1161/CIRCULATIONAHA.121.058544. Epub 2022 Jun 3.

Authors

Chunrong Tao^#¹, Adnan I Qureshi^#², Yamei Yin¹, Jie Li¹, Rui Li¹, Pengfei Xu¹, Jun Sun¹, Geng Liao^#³, Xincan Yue⁴, Hongchao Shi⁵, Yongchang Liu⁶, Zhengfei Ma⁷, Jinhua Zhang⁸, Guodong Xiao⁹, Bo Xu¹⁰, Chenghua Xu¹¹, Junfeng Su¹², Wensheng Zhou¹³, Shuchun Huang¹⁴, Weimin Yang¹⁵, Hongbing Chen¹⁶, Wei Li¹⁷, Yongkun Li¹⁸, Dezhi Liu¹⁹, Chuanqing Yu²⁰, Guangxiong Yuan²¹, Chaobin Wang²², Wenbao Liang²³, Chun Chen²⁴, Xueying Shi²⁵, Junjun Wang²⁶, Yingchun Wu²⁶, Xueli Cai²⁷, Chunyun Shen²⁸, Kai Li²⁹, Pu Fang³⁰, Ming Wang³¹, Zhongjun Chen³², Tong Li³³, Guangsen Cheng³⁴, Yaxuan Sun³⁵, Yan Wang^{36

37}, Hui Zhang³⁸, Jie Chen³⁹, Xiaohui Xu⁴⁰, Youmeng Wang⁴¹, Wanjie Geng⁴², Chuyuan Ni⁴³, Changchun Chen⁴⁴, Yan Liu⁴⁵, Jie Min⁴⁶, Yongcheng Zhang⁴⁷, Yong Liang⁴⁸, Chao Wen⁴⁹, Blaise W Baxter⁵⁰, Raul G Nogueira⁵¹, Wei Hu¹; ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion) Trial Investigators

Affiliations

¹ Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei Anhui, 230001, China (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.).
² Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis (A.I.Q.).
³ Department of Neurology, Maoming People's Hospital, Guangdong, China (G.L.).
⁴ Department of Neurosurgery, Zhoukou Central Hospital, China (X.Y.).
⁵ Department of Neurology, Nanjing First Hospital, China (H.S.).
⁶ Department of Neurovascular Intervention, Cangzhou Central Hospital, China (Yongchang Liu).
⁷ Department of Neurology, Suzhou Municipal Hospital, China (Z.M.).
⁸ Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z.).
⁹ Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, China (G.X.).
¹⁰ Department of Neurology, Qingdao Central Hospital, Qingdao University, China (B.X.).
¹¹ Department of Neurology, Taizhou First People's Hospital, China (C.X.).
¹² Department of Neurology, Jingzhou Central Hospital, China (J.Su).
¹³ Department of Neurology, Hunan Provincial People's Hospital, Changsha, China (W.Z.).
¹⁴ Department of Neurology, Hospital 302 Attached to Guizhou Aviation Group, Guizhou, China (S.H.).
¹⁵ Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China (W.Y.).
¹⁶ Department of Neurology and Stroke Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (H.C.).
¹⁷ Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, China (W.Li).
¹⁸ Department of Neurology, Fujian Provincial Hospital, Fuzhou, China (Y.Li).
¹⁹ Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, China (D.L.).
²⁰ Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China (C.Y.).
²¹ Department of Emergency, Xiangtan Central Hospital, China (G.Y.).
²² Department of Neurology, Liangxiang Hospital, Fangshan District, Beijing, China (C.W.).
²³ Department of Neurology, Karamay Central Hospital, China (W.Liang).
²⁴ Department of Neurology, The First Affiliated Hospital of Kunming Medical University, China (Chun Chen).
²⁵ Department of Neurology, Anqing Hospital Affiliated to Anhui Medical University, China (X.S.).
²⁶ Department of Neurology, General Hospital of Wan-bei Coal and Electricity Group, The Third Hospital Affiliated of Bengbu Medical College, Suzhou, China (J.W.).
²⁷ Department of Neurology, Lishui Municipal Central Hospital, China (X.C.).
²⁸ Department of Neurology, Central People's Hospital of Zhanjiang, Guangdong, China (C.S.).
²⁹ Department of Neurology, Heze Municipal Hospital, China (K.L.).
³⁰ Department of Neurology, The First Affiliated Hospital of Nanchang University, China (P.F.).
³¹ Department of Neurology, Nanyang Second General Hospital, China (M.W.).
³² Department of Neurosurgical Intervention, Dalian Municipal Central Hospital, China (Z.C.).
³³ Department of Neurology, The Second People's Hospital of Nanning, China (T.L.).
³⁴ Department of Neurology, The First Affiliated Hospital of Medicine Macau University of Technology, Zhuhai, China (G.C.).
³⁵ Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China (Y.S.).
³⁶ Department of Neurology, ORDOS Central Hospital, ORDOS, China (Y.Wu).
³⁷ Department of Neurology, Chengdu Fifth People's Hospital, China (Y.Wang).
³⁸ Department of Neurosurgery, The Second Affiliated Hospital of Bengbu Medical College, China (H.Z.).
³⁹ Department of Neurosurgery, Tongling People's Hospital, China (J.C.).
⁴⁰ Department of Neurology, Taizhou Municipal Hospital, China (X.X.).
⁴¹ Department of Neurology, Fuyang People's Hospital, China (Y.Wang.).
⁴² Department of Neurology, Taihe County People's Hospital, China (W.G.).
⁴³ Department of Neurology, Huangshan People's Hospital, China (C.N.).
⁴⁴ Department of Neurology, The Second People's Hospital of Anhui Province, Hefei, China (Changchun Chen).
⁴⁵ Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, China (Yan Liu).
⁴⁶ Department of Neurosurgery, Jingzhou First People's Hospital, China (J.M.).
⁴⁷ Department of Neurology, Affiliated Hospital of Jinggangshan University, Ji'an, China (Y.Z.).
⁴⁸ Department of Neurology, Changsha First Hospital, China (Y.Liang).
⁴⁹ Department of Neurology, Taiyuan Central Hospital, China (C.W.).
⁵⁰ Lehigh Valley Health Network, Allentown, PA (B.W.B.).
⁵¹ UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, PA (R.G.N.).

^# Contributed equally.

PMID: 35656816
DOI: 10.1161/CIRCULATIONAHA.121.058544

Abstract

Background: The authors compare the effectiveness and safety of endovascular treatment (EVT) versus best medical management (BMM) in strokes attributable to acute basilar artery occlusion (BAO).

Methods: The present analysis was based on the ongoing, prospective, multicenter ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion) trial registry in China. Our analytic sample comprised 2134 patients recruited at 48 sites between 2017 and 2021 and included 462 patients who received BMM and 1672 patients who received EVT. We performed an inversed probability of treatment weighting analysis. Qualifying patients had to present within 24 hours of estimated BAO. The primary clinical outcome was favorable functional outcome (modified Rankin Scale score, 0-3) at 90 days. We also performed a sensitivity analysis with the propensity score matching-based and the instrumental variable-based analysis.

Results: In our primary analysis using the inversed probability of treatment weighting-based analysis, there was a significantly higher rate of favorable outcome at 90 days among EVT patients compared with BMM-treated patients (adjusted relative risk, 1.42 [95% CI, 1.19-1.65]; absolute risk difference, 11.8% [95% CI, 6.9-16.7]). The mortality was significantly lower (adjusted relative risk, 0.78 [95% CI, 0.69-0.88]; absolute risk difference, -10.3% [95% CI, -15.8 to -4.9]) in patients undergoing EVT. Results were generally consistent across the secondary end points. Similar associations were seen in the propensity score matching-based and instrumental variable-based analysis.

Conclusions: In this real-world study, EVT was associated with significantly better functional outcomes and survival at 90 days. Well-designed randomized studies comparing EVT with BMM in the acute BAO are needed.

Registration: URL: www.chictr.org.cn; Unique identifier: ChiCTR2000041117.

Keywords: basilar artery; observational study; stroke; thrombectomy.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Arterial Occlusive Diseases* / therapy
Basilar Artery
Endovascular Procedures* / adverse effects
Endovascular Procedures* / methods
Humans
Prospective Studies
Registries
Stroke*
Thrombectomy / methods
Treatment Outcome