Endovascular treatment for acute basilar artery occlusion due to different stroke etiologies of large artery atherosclerosis and cardioembolism

Huihui Liu; Guoyong Zeng; Hongliang Zeng; Yang Yu; Feixue Yue; Yingbing Ke; Zhizhong Yan; Jie Pu; Jun Zhang; Wan Wei; Dengke He; Yupeng Wu; Xianjun Huang; Peiyang Zhou

doi:10.1177/23969873221101285

Endovascular treatment for acute basilar artery occlusion due to different stroke etiologies of large artery atherosclerosis and cardioembolism

Eur Stroke J. 2022 Sep;7(3):238-247. doi: 10.1177/23969873221101285. Epub 2022 May 21.

Authors

Huihui Liu¹, Guoyong Zeng², Hongliang Zeng², Yang Yu³, Feixue Yue⁴, Yingbing Ke⁵, Zhizhong Yan⁶, Jie Pu⁷, Jun Zhang⁸, Wan Wei⁹, Dengke He¹⁰, Yupeng Wu¹¹, Xianjun Huang¹², Peiyang Zhou¹³

Affiliations

¹ Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
² Department of Neurology, Ganzhou People's Hospital, Ganzhou, China.
³ Department of Neurology, Nanyang Central Hospital, Nanyang, China.
⁴ Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China.
⁵ Department of Neurology, Yangluo Branch of Hubei Zhongshan Hospital, Wuhan, China.
⁶ Department of Neurology, The 904th Hospital of The People's Liberation Army, Wuxi, China.
⁷ Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China.
⁸ Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
⁹ Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
¹⁰ Department of Neurology, Air Force Health Care Center For Special Services Hangzhou, Hangzhou, China.
¹¹ Department of Neurology, Xuzhou Central Hospital, Xuzhou, Chin.
¹² Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China.
¹³ Department of Neurology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China.

Abstract

Introduction: Stroke etiology may affect the prognosis of acute basilar artery occlusion (BAO). This study aimed to estimate the efficacy and safety of endovascular treatment (EVT) in BAO strokes due to the underlying stroke etiologies of large artery atherosclerosis (LAA) and cardioembolism (CE).

Patients and methods: Patients with LAA and CE subtypes from the registry EVT for Acute Basilar Artery Occlusion Study (BASILAR) were selected for this analysis. We estimated the EVT treatment effect relative to standard medical treatment (SMT) in these patients by using a propensity score approach with inverse probability of treatment weighted estimation. Outcomes included 90-day favorable functional outcomes (modified Rankin scale (mRS) 0-3), functional independence (mRS 0-2), all-cause mortality, and symptomatic intracranial hemorrhage (sICH).

Results: A total of 744 patients were included in the final analysis. After weighting with inverse probability of treatment estimation, the patients who, based on their characteristics, were treated with EVT rather than SMT, demonstrated higher rates of favorable functional outcomes in both the LAA (29.2% vs 11.7%, adjusted OR with 95% CI: 4.34 [2.15-8.78], p < 0.001) and the CE subtype (36.0% vs 8.1%, adjusted OR with 95% CI: 9.14 [1.96-42.55], p = 0.005). A similar finding was also observed for functional independence. EVT patients also demonstrated lower rates of mortality than SMT. Among EVT patients, no significant difference was observed in mortality or sICH between LAA and CE groups, but LAA patients had lower rates of favorable functional outcome and functional independence (29.2% vs 37% and 24.2% vs 32.9%, respectively), where the latter remained significant after adjustment for imbalances in baseline data (p = 0.04).

Conclusions: In acute BAO strokes, both LAA and CE patients who, based on their characteristics, were treated with EVT rather than SMT, demonstrated better outcomes. Among EVT patients, LAA and CE subtypes displayed important baseline and treatment differences, and LAA patients were less likely to achieve functional independence at 3 months, but mortality and sICH were similar between LAA or CE subtypes. These results need to be confirmed in future clinical trials.

Keywords: Basilar artery occlusion; endovascular treatment; outcome; stroke etiology.