Reperfusion treatment in basilar artery occlusion presenting with mild symptoms

Schwarz, Ghil; Cascio Rizzo, Angelo; Matusevicius, Marius; Moreira, Tiago; Vilionskis, Aleksandras; Naldi, Andrea; Martinez-Majander, Nicolas; Bigliardi, Guido; Toni, Danilo; Roffe, Christine; Agostoni, Elio Clemente; Ahmed, Niaz

Abstract

Introduction:
Endovascular treatment (EVT) improves outcomes for basilar artery occlusion (BAO) with moderate-to-severe symptoms. However, the best treatment for mild symptoms (NIHSS score 0–10 and 0–5) remains unclear. This study compared EVT ± IVT to IVT alone in BAO patients with mild symptoms.

Patients and Methods:
From the SITS-International Stroke Treatment Register, we included BAO patients with available baseline NIHSS score, treated by EVT, IVT, or both within 6 h of symptom onset from 2013 to 2021. Using the Doubly Robust approach (propensity score matching plus multivariable logistic regression), we analyzed efficacy (3-month mRS) and safety (SICH and 3-month death) outcomes for EVT ± IVT versus IVT alone in BAO patients with NIHSS scores 0–10 and 0–5.

Results:
1426 patients were included. For NIHSS scores 0–10 (180 matched, 1:1 ratio), outcomes were similar between EVT ± IVT and IVT alone groups. For NIHSS scores 0–5 (89 matched, 1:1 ratio), EVT ± IVT was associated with worse outcomes compared to IVT alone (mRS 0–2, aOR 0.20 [95% CI 0.06–0.61]; p = 0.005; mRS 0–3, aOR 0.27 [95% CI 0.08–0.89]; p = 0.031), but safety outcomes were similar.

Discussion:
In early-treated BAO patients with mild symptoms, defined as NIHSS 0–10, there were no significant differences in outcomes between EVT ± IVT and IVT alone. However, for very mild symptoms, defined as NIHSS 0–5, IVT alone was associated with better outcomes compared to EVT ± IVT.

Conclusion:
Randomized trials are crucial to determine the optimal reperfusion therapy for BAO patients with mild symptoms.

Citation

Schwarz, G., Cascio Rizzo, A., Matusevicius, M., Moreira, T., Vilionskis, A., Naldi, A., …Ahmed, N. (in press). Reperfusion treatment in basilar artery occlusion presenting with mild symptoms. European Stroke Journal, https://doi.org/10.1177/23969873241272517

• Journal Article Type: Article
• Acceptance Date: Jul 14, 2024
• Online Publication Date: Aug 20, 2024
• Deposit Date: Oct 15, 2024
• Journal: European Stroke Journal
• Print ISSN: 2396-9873
• Electronic ISSN: 2396-9881
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/23969873241272517
• Keywords: Basilar artery occlusion, mild symptoms, ischemic stroke
• Public URL: https://keele-repository.worktribe.com/output/890066
• Publisher URL: https://journals.sagepub.com/doi/10.1177/23969873241272517