BRIDGING TRIAL EVIDENCE AND CLINICAL REALITY: REAL-WORLD EFFECTIVENESS OF ENDOVASCULAR THERAPY IN BASILAR ARTERY OCCLUSION

초록

Background and Aims: The ATTENTION and BAOCHE trials demonstrated the efficacy of endovascular treatment (EVT) for acute basilar artery occlusion (BAO) in carefully selected populations. Methods: We conducted a retrospective analysis of a nationwide, multicenter, prospectively collected stroke database. This study included patients with BAO who presented within 24 hours of the time last seen well (TLSW). Trial eligibility was assessed using the eligibility criteria of each trial including neuroimaging parameters. To evaluate the effectiveness of EVT, patients were categorized into three groups: ATTENTION-eligible, BAOCHE-eligible, and ineligible for both trials. Outcomes were modified Rankin scale (mRS) score of 0-3 and 0-2, mRS distribution, and mortality at 3 months, and symptomatic intracranial hemorrhage. Results: Among 49,471 patients presenting within 24 hours of TLSW, 2 % were diagnosed with BAO. Of these, 24 % met the ATTENTION criteria and 6 % met the BAOCHE criteria, while 72 % were ineligible for either trial. EVT was performed in 75 % of ATTENTION-eligible patients, 59 % of BAOCHE-eligible patients, and 43 % of patients ineligible for both trials. In ATTENTION-eligible patients, EVT was significantly associated with a favorable mRS distribution and reduced 3-month mortality. In BAOCHE-eligible patients, there were trends toward improved mRS distribution and lower mortality, though not statistically significant. Notably, EVT was associated with lower mortality and potentially improved 3-month functional outcomes even among patients ineligible for both trials. Conclusions: The effectiveness of EVT showed potential reproducibility in ATTENTION-eligible patients and BAOCHE-eligible patients. The observed mortality reduction among patients outside the trials’ eligibility criteria highlights the need to refine and broaden EVT candidacy for BAO.