Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion

Tao, Chunrong; Nogueira, Raul G; Zhu, Yuyou; Sun, Jun; Han, Hongxing; Yuan, Guangxiong; Wen, Changming; Zhou, Peiyang; Chen, Wenhuo; Zeng, Guoyong; Li, Yuwen; Ma, Z.Y.; Yu, Chuanqing; Su, Junfeng; Zhou, Zhiming; Chen, Zhongjun; Liao, Geng; Sun, Yulin; Ren, Youquan; Zhang, Hui; Chen, Jie; Yue, Xincan; Xiao, Guodong; Wang, Li; Li, Rui; Liu, Wenhua; Liu, Yong; Wang, Li; Zhang, Chao; Liu, Tianlong; Song, Jianlong; Xu, Pengfei; Yin, Yamei; Wang, Guoping; Baxter, Blaise; Qureshi, Adnan I; Liu, Xinfeng; Hu, Wei

doi:10.1056/nejmoa2206317

Cited by 239 publications

(172 citation statements)

References 23 publications

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“…Two previously published randomized controlled trials (RCT), the BEST study and the BASICS study, both failed to prove the superiority of MT over standard medical treatment [3,4]. However, just recently, two RCTs (BAOCHE study and ATTENTION study) which focused on moderate-to-severe stroke (NIHSS ≥ 10), first confirmed that MT significantly improved the functional outcome of AVBAO [5,6]. Patients with AVBAO often have typical vascular risk factors, one of the most common stroke subtypes is large artery atherosclerosis (LAA) [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Influence of tirofiban on stroke outcome after mechanical thrombectomy in acute vertebrobasilar artery occlusion

Pan

Fei

et al. 2022

BMC Neurol

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Background Even undergoing mechanical thrombectomy (MT), patients with acute vertebrobasilar artery occlusion (AVBAO) still have a high rate of mortality. Tirofiban is a novel antiplatelet agent which is now widely empirically used in acute ischemic stroke (AIS). In this study, we aimed to evaluate the safety and efficacy of tirofiban as adjunctive therapy for MT in AVBAO. Methods From October 2016 to July 2021, consecutive AVBAO patients receiving MT were included in the prospective stroke registry. The short-term outcomes were (1) symptomatic intracerebral hemorrhage (sICH); (2) in-hospital death; (3) National Institute of Health Stroke Scale (NIHSS) at discharge. The Long-term outcomes were: (1) modified Rankin Scale (mRS) at 3 months; (2) death at 3 months. Results A total of 130 eligible patients were included in the study, 64 (49.2%) patients received tirofiban. In multivariate regression analysis, no significant differences were observed in all outcomes between the tirofiban and non-tirofiban group [sICH (adjusted OR 0.96; 95% CI, 0.12–7.82, p = 0.97), in-hospital death (adjusted OR 0.57; 95% CI, 0.17–1.89, p = 0.36), NIHSS at discharge (95% CI, -2.14–8.63, p = 0.24), mRS (adjusted OR 1.20; 95% CI, 0.40–3.62, p = 0.75), and death at 3 months (adjusted OR 0.83; 95% CI, 0.24–2.90, p = 0.77)]. Conclusions In AVBAO, tirofiban adjunctive to MT was not associated with an increased risk of sICH. Short-term (in-hospital death, NIHSS at discharge) and long-term outcomes (mRS and death at 3 months) seem not to be influenced by tirofiban use.

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Section: Introductionmentioning

confidence: 99%

Influence of tirofiban on stroke outcome after mechanical thrombectomy in acute vertebrobasilar artery occlusion

Pan

Fei

et al. 2022

BMC Neurol

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“…Timely identi cation of BAO by imaging examination is very important. Current clinical studies have shown that EVT can improve the outcome of patients with BAO [3][4][5]. Direct thrombaspiration may be a more effective approach, which can improve the rate of complete reperfusion, reduces procedure duration, and reduce the risk of distal embolization of fragmented thrombi [8].…”

Section: Discussionmentioning

confidence: 99%

“…Basilar artery occlusion (BAO) is a fatal ischemic stroke that accounts for about 1% [1] of all strokes and 10% of all large vessel occlusions that is amendable to endovascular treatment (EVT) [2]. Clinical evidence on thrombectomy for BAO has gradually increased [3][4][5], but large-sample clinical studies of posterior circulation distal moderate vessel thrombectomy are still lacking. Convulsive seizure is a rare initial presentation in BAO patients.…”

Section: Introductionmentioning

confidence: 99%

Atrial Myxoma Embolization of the Basilar Artery Presenting with a Convulsive Seizure

Xu¹,

Jiang²,

Zhang³

2022

Preprint

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Atrial myxoma is a rare cause of acute ischemic stroke. A small number of patients with basilar artery occlusion (BAO) present with convulsive seizures. We have herein presented a case of atrial myxoma embolization of the basilar artery, resulting in convulsions as the initial symptom. This patient was treated with atrial myxoma resection following endovascular treatment with a favorable outcome. This case illustrates the importance of timely diagnosis of BAO with atypical symptoms. Endovascular treatment for distal moderate vascular occlusion in posterior circulation is feasible, and atrial myxoma should be resected as soon as possible to prevent further embolic complications.

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“…The ATTENTION ([Endovascular Treatment for Acute Basilar Artery Occlusion: A Multicenter Randomized Controlled Trial]; n=340 treated 0-12 hours after onset) 4 and BAOCHE ([Basilar Artery Occlusion Chinese Endovascular]; n=217 treated 6-24 hours after onset) 3 randomized trials performed in China both demonstrated a strong benefit in reduced disability with >20% absolute improvement in ambulatory outcome (mRS score 0-3) in patients with moderate to severe neurologic deficits (NIHSS score ≥10 and NIHSS score ≥6, respectively). These results followed the neutral primary outcomes in BASICS ([Basilar Artery International Cooperation Study]; n=300 treated 0-6 hours after onset) 9 and BEST ([Acute Basilar Artery Occlusion: Endovascular Interventions vs Standard Medical Treatment]; n=131 treated 0-8 hours after onset).…”

Section: Evt Is Effective For Patients With Moderate To Severe Neurol...mentioning

confidence: 99%

“…2 Two trials demonstrated clear benefit of EVT in patients with moderate to severe neurologic deficits due to basilar artery occlusion. 3,4 Additional data on thrombolytic plus EVT and the use of adjunctive treatments with EVT have been reported. 5 The Intravenous tenecteplase compared with alteplase for acute ischemic stroke in Canada (AcT [Alteplase Compared to Tenecteplase in Patients With Acute Ischemic Stroke]) trial showed that intravenous tenecteplase is noninferior to intravenous alteplase when administered within 4.5 hours of stroke onset.…”

mentioning

confidence: 99%