Real-World Outcomes of Endovascular Thrombectomy for Basilar Artery Occlusion: Results of the BArONIS Study.

Autor: Dicpinigaitis AJ; School of Medicine, New York Medical College, Valhalla, NY., Dick-Godfrey R; School of Medicine, New York Medical College, Valhalla, NY., Gellerson O; School of Medicine, New York Medical College, Valhalla, NY., Shapiro SD; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY., Kamal H; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY., Ghozy S; Departments of Neurology and Neurosurgery, Mayo Clinic, Rochester, MN., Kaur G; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY., Desai SM; Department of Neurology and Neurosurgery, Barrow Neurological Institute, Phoenix, AZ., Ortega-Gutierrez S; Department of Neurology, Neurosurgery and Radiology, University of Iowa Healthcare, Iowa City, IA., Yaghi S; Department of Neurology, Rhode Island Hospital at the Warren Alpert Medical School of Brown University, Providence, RI., Altschul DJ; Department of Neurological Surgery and Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY., Jadhav AP; Department of Neurology and Neurosurgery, Barrow Neurological Institute, Phoenix, AZ., Hassan AE; Department of Neurology and Neurosurgery, University of Texas Rio Grande Valley, Edinburg, TX and Valley Baptist Medical Center, Harlingen, TX., Nguyen TN; Department of Neurology and Neurosurgery, Boston Medical Center at the Boston University School of Medicine, Boston, MA., Brook AL; Department of Neurological Surgery and Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY., Mayer SA; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY., Jovin TG; Department of Neurology, Cooper University Hospital, Camden, NJ., Nogueira RG; UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA., Gandhi CD; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY., Al-Mufti F; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY.
Jazyk: angličtina
Zdroj: Annals of neurology [Ann Neurol] 2023 Jul; Vol. 94 (1), pp. 55-60. Date of Electronic Publication: 2023 Mar 21.
DOI: 10.1002/ana.26640
Abstrakt: Objective: To evaluate clinical outcomes of endovascular thrombectomy (EVT) for acute basilar artery occlusion (BAO) using population-level data from the United States.
Methods: Weighted discharge data from the National Inpatient Sample were queried to identify adult patients with acute BAO during the period of 2015 to 2019 treated with EVT or medical management only. Complex samples statistical methods and propensity-score adjustment using inverse probability of treatment weighting (IPTW) were performed to assess clinical endpoints.
Results: Among 3,950 BAO patients identified, 1,425 (36.1%) were treated with EVT [mean age 66.7 years, median National Institute of Health Stroke Scale (NIHSS) score 22]. On unadjusted analysis, 155 (10.9%) EVT patients achieved favorable functional outcomes (discharge disposition to home without services), while 515 (36.1%) experienced in-hospital mortality, and 20 (1.4%) developed symptomatic intracranial hemorrhage (sICH). Following propensity-score adjustment by IPTW accounting for age, stroke severity, and comorbidity burden, EVT was independently associated with favorable functional outcome [adjusted odds ratio (aOR) 1.25, 95% confidence interval (CI) 1.07, 1.46; p = 0.004], but not with in-hospital mortality or sICH. In an IPTW-adjusted sub-group analysis of patients with NIHSS scores >20, EVT was associated with both favorable functional outcome (discharge disposition to home or to acute rehabilitation) (aOR 1.55, 95% CI 1.24, 1.94; p < 0.001) and decreased mortality (aOR 0.78, 95% CI 0.69, 0.89; p < 0.001), but not with sICH.
Interpretation: This retrospective population-based analysis using a large national registry provides real-world evidence of a potential benefit of EVT in acute BAO patients. ANN NEUROL 2023;94:55-60.
(© 2023 American Neurological Association.)
Databáze: MEDLINE
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