Abstract：
UNASSIGNED: Stroke etiology could influence the outcomes in patients with basilar-artery occlusion (BAO). This study aimed to evaluate the differences in efficacy and safety of best medical treatment (BMT) plus endovascular treatment (EVT) versus BMT alone in acute BAO across different stroke etiologies.
UNASSIGNED: The study was a post hoc analysis of the ATTENTION trial (Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion), which was a multicenter, randomized trial at 36 centers in China from February 2021 to September 2022. Patients with acute BAO were classified into 3 groups according to stroke etiology (large-artery atherosclerosis [LAA], cardioembolism, and undetermined cause/other determined cause [UC/ODC]). The primary outcome was a favorable outcome (modified Rankin Scale score of 0-3) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 90-day mortality.
UNASSIGNED: A total of 340 patients with BAO were included, 150 (44.1%) had LAA, 72 (21.2%) had cardioembolism, and 118 (34.7%) had UC/ODC. For patients treated with BMT plus EVT and BMT alone, respectively, the rate of favorable outcome at 90 days was 49.1% and 23.8% in the LAA group (odds ratio, 3.08 [95% CI, 1.38-6.89]); 52.2% and 30.8% in the cardioembolism group (odds ratio, 2.45 [95% CI, 0.89-6.77]); and 37.5% and 17.4% in the UC/ODC group (odds ratio, 2.85 [95% CI, 1.16-7.01]), with P=0.89 for the stroke etiology×treatment interaction. The rate of symptomatic intracranial hemorrhage in EVT-treated patients with LAA, cardioembolism, and UC/ODC was 8.3%, 2.2%, and 3.2%, respectively, and none of the BMT-treated patients. Lower 90-day mortality was observed in patients with EVT compared with BMT alone across 3 etiology groups.
UNASSIGNED: Among patients with acute BAO, EVT compared with BMT alone might be associated with favorable outcomes and lower 90-day mortality, regardless of cardioembolism, LAA, or UC/ODC etiologies. The influence of stroke etiology on the benefit of EVT should be explored by further trials.
UNASSIGNED: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04751708.
UNASSIGNED: The study was a post hoc analysis of the ATTENTION trial (Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion), which was a multicenter, randomized trial at 36 centers in China from February 2021 to September 2022. Patients with acute BAO were classified into 3 groups according to stroke etiology (large-artery atherosclerosis [LAA], cardioembolism, and undetermined cause/other determined cause [UC/ODC]). The primary outcome was a favorable outcome (modified Rankin Scale score of 0-3) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 90-day mortality.
UNASSIGNED: A total of 340 patients with BAO were included, 150 (44.1%) had LAA, 72 (21.2%) had cardioembolism, and 118 (34.7%) had UC/ODC. For patients treated with BMT plus EVT and BMT alone, respectively, the rate of favorable outcome at 90 days was 49.1% and 23.8% in the LAA group (odds ratio, 3.08 [95% CI, 1.38-6.89]); 52.2% and 30.8% in the cardioembolism group (odds ratio, 2.45 [95% CI, 0.89-6.77]); and 37.5% and 17.4% in the UC/ODC group (odds ratio, 2.85 [95% CI, 1.16-7.01]), with P=0.89 for the stroke etiology×treatment interaction. The rate of symptomatic intracranial hemorrhage in EVT-treated patients with LAA, cardioembolism, and UC/ODC was 8.3%, 2.2%, and 3.2%, respectively, and none of the BMT-treated patients. Lower 90-day mortality was observed in patients with EVT compared with BMT alone across 3 etiology groups.
UNASSIGNED: Among patients with acute BAO, EVT compared with BMT alone might be associated with favorable outcomes and lower 90-day mortality, regardless of cardioembolism, LAA, or UC/ODC etiologies. The influence of stroke etiology on the benefit of EVT should be explored by further trials.
UNASSIGNED: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04751708.
摘要：
■卒中病因可能会影响基底动脉闭塞（BAO）患者的预后。这项研究旨在评估不同卒中病因的急性BAO中最佳药物治疗（BMT）加血管内治疗（EVT）与单独BMT的疗效和安全性差异。
■该研究是对注意试验（急性基底动脉阻塞的血管内治疗试验）的事后分析，这是一个多中心，2021年2月至2022年9月在中国36个中心进行的随机试验。急性BAO患者根据卒中病因分为3组（大动脉粥样硬化[LAA]，心脏栓塞,和未确定原因/其他确定原因[UC/ODC])。主要结果是90天的有利结果（改良的Rankin量表评分为0-3）。安全性结果包括症状性颅内出血和90天死亡率。
■共纳入340例BAO患者，150人(44.1%)有左心耳，72人（21.2%）有心源性栓塞，118例（34.7%）患有UC/ODC。对于接受BMT加EVT和仅接受BMT治疗的患者，分别,LAA组90天时的有利结局率分别为49.1%和23.8%(比值比,3.08[95%CI，1.38-6.89])；心栓塞组为52.2%和30.8%(比值比，2.45[95%CI，0.89-6.77]）；UC/ODC组的37.5%和17.4%（比值比，2.85[95%CI，1.16-7.01])，卒中病因×治疗交互作用P=0.89。EVT治疗的LAA患者的症状性颅内出血率，心脏栓塞,UC/ODC为8.3%，2.2%,和3.2%，分别,也没有接受BMT治疗的患者.在3个病因组中，与单独的BMT相比，EVT患者的90天死亡率较低。
■在急性BAO患者中，与单独的BMT相比，EVT可能与有利的结果和更低的90天死亡率相关。不管心脏栓塞,LAA,或UC/ODC病因。卒中病因对EVT益处的影响应通过进一步的试验来探索。
■URL：https://www。clinicaltrials.gov；唯一标识符：NCT04751708。
■该研究是对注意试验（急性基底动脉阻塞的血管内治疗试验）的事后分析，这是一个多中心，2021年2月至2022年9月在中国36个中心进行的随机试验。急性BAO患者根据卒中病因分为3组（大动脉粥样硬化[LAA]，心脏栓塞,和未确定原因/其他确定原因[UC/ODC])。主要结果是90天的有利结果（改良的Rankin量表评分为0-3）。安全性结果包括症状性颅内出血和90天死亡率。
■共纳入340例BAO患者，150人(44.1%)有左心耳，72人（21.2%）有心源性栓塞，118例（34.7%）患有UC/ODC。对于接受BMT加EVT和仅接受BMT治疗的患者，分别,LAA组90天时的有利结局率分别为49.1%和23.8%(比值比,3.08[95%CI，1.38-6.89])；心栓塞组为52.2%和30.8%(比值比，2.45[95%CI，0.89-6.77]）；UC/ODC组的37.5%和17.4%（比值比，2.85[95%CI，1.16-7.01])，卒中病因×治疗交互作用P=0.89。EVT治疗的LAA患者的症状性颅内出血率，心脏栓塞,UC/ODC为8.3%，2.2%,和3.2%，分别,也没有接受BMT治疗的患者.在3个病因组中，与单独的BMT相比，EVT患者的90天死亡率较低。
■在急性BAO患者中，与单独的BMT相比，EVT可能与有利的结果和更低的90天死亡率相关。不管心脏栓塞,LAA,或UC/ODC病因。卒中病因对EVT益处的影响应通过进一步的试验来探索。
■URL：https://www。clinicaltrials.gov；唯一标识符：NCT04751708。
