Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion

• Main Authors: Ding, Y. (Author), Duan, W. (Author), Gu, W. (Author), Hou, X. (Author), Leng, X. (Author), Liu, D. (Author), Liu, J. (Author), Liu, L. (Author), Liu, X. (Author), Lu, Q. (Author), Miao, Z. (Author), Nie, X. (Author), Pan, Y. (Author), Pu, Y. (Author), Wang, D. (Author), Wei, Y. (Author), Wen, M. (Author), Yan, H. (Author), Yang, X. (Author), Yang, Z. (Author), Zhang, Z. (Author), Zheng, L. (Author)
• Format: Article
• Language: English
• Published: NLM (Medline) 2022
• Subjects: adverse event; Arterial Occlusive Diseases; basilar artery; Basilar Artery; brain ischemia; Brain Ischemia; cerebrovascular accident; cohort analysis; Cohort Studies; diagnostic imaging; human; Humans; Ischemic Stroke; meta analysis; Multicenter Studies as Topic; multicenter study (topic); peripheral occlusive artery disease; stroke; Stroke; thrombectomy; Thrombectomy; thrombolysis; tissue plasminogen activator; Tissue Plasminogen Activator; treatment outcome; Treatment Outcome
• Online Access: View Fulltext in Publisher

 BACKGROUND AND PURPOSE: It remains controversial if endovascular treatment (EVT) can improve the outcome of patients with acute basilar artery occlusion (BAO). This study aims to compare the functional outcomes between EVT with and without intravenous thrombolysis (IVT) first in patients who had acute ischaemic stroke (AIS) due to BAO. METHODS: Patients who had AIS with BAO who underwent EVT within 24 hours of onset were enrolled in this multicentre cohort study, and the efficacy and safety were compared between IVT+EVT and direct EVT. The primary outcome was 90-day functional independence. All outcomes were assessed with adjusted OR (aOR) from the multivariable logistic regression. In addition, a meta-analysis was performed on all recently published pivotal studies on functional independence after EVT in patients with BAO. RESULTS: Of 310 enrolled patients with BAO, 241 (78%) were treated with direct EVT and 69 (22%) with IVT+EVT. Direct EVT was associated with a worse functional outcome (aOR, 0.46 (95% CI 0.24 to 0.85), p=0.01). IVT+EVT was associated with a lower percentage of patients who needed ≥3 passes of stent retriever (10.14% vs 20.75%). The meta-analysis regression revealed a potential positive correlation between bridging with IVT first and functional independence (r=0.14 (95% CI 0.05 to 0.24), p<0.01). CONCLUSIONS: This study showed that compared with direct EVT, EVT with IVT first was associated with better functional outcomes in patients with BAO treated within 24 hours of onset. The meta-analysis demonstrated similar favourable efficacy of IVT first followed by EVT in patients with BAO. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.