Titre
Endovascular Therapy for Stroke Due to Basilar-Artery Occlusion.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Langezaal, LCM
Auteure/Auteur
van der Hoeven, EJRJ
Auteure/Auteur
Mont'Alverne, FJA
Auteure/Auteur
de Carvalho, JJF
Auteure/Auteur
Lima, F.O.
Auteure/Auteur
Dippel, DWJ
Auteure/Auteur
van der Lugt, A.
Auteure/Auteur
Lo, RTH
Auteure/Auteur
Boiten, J.
Auteure/Auteur
Lycklama À Nijeholt, G.J.
Auteure/Auteur
Staals, J.
Auteure/Auteur
van Zwam, W.H.
Auteure/Auteur
Nederkoorn, P.J.
Auteure/Auteur
Majoie, CBLM
Auteure/Auteur
Gerber, J.C.
Auteure/Auteur
Mazighi, M.
Auteure/Auteur
Piotin, M.
Auteure/Auteur
Zini, A.
Auteure/Auteur
Vallone, S.
Auteure/Auteur
Hofmeijer, J.
Auteure/Auteur
Martins, S.O.
Auteure/Auteur
Nolte, C.H.
Auteure/Auteur
Szabo, K.
Auteure/Auteur
Dias, F.A.
Auteure/Auteur
Abud, D.G.
Auteure/Auteur
Wermer, MJH
Auteure/Auteur
Remmers, MJM
Auteure/Auteur
Schneider, H.
Auteure/Auteur
Rueckert, C.M.
Auteure/Auteur
de Laat, K.F.
Auteure/Auteur
Yoo, A.J.
Auteure/Auteur
van Doormaal, P.J.
Auteure/Auteur
van Es, ACGM
Auteure/Auteur
Emmer, B.J.
Auteure/Auteur
Michel, P.
Auteure/Auteur
Puetz, V.
Auteure/Auteur
Audebert, H.J.
Auteure/Auteur
Pontes-Neto, O.M.
Auteure/Auteur
Vos, J.A.
Auteure/Auteur
Kappelle, L.J.
Auteure/Auteur
Algra, A.
Auteure/Auteur
Schonewille, W.J.
Auteure/Auteur
Contributrices/contributeurs
Schonewille, W.J.
Vos, J.A.
van der Hoeven, EJRJ
Langezaal, LCM
van Leersum, M.
van den Heuvel, DAF
van Strijen, MJL
Teunissen, L.L.
Dippel, DWJ
van der Lugt, A.
van Es, ACGM
van Doormaal, P.J.
Kappelle, L.J.
Lo, T.H.
van der Worp, H.B.
Boiten, J.
Lycklama À Nijeholt, G.J.
Nederkoorn, P.J.
Majoie, CBLM
Coutinho, J.
Emmer, B.J.
Staals, J.
van Zwam, W.H.
Hofmeijer, J.
Martens, J.
Bernsen, M.L.
Wermer, MJH
van Walderveen, MAA
Remmers, MJM
de Laat, K.F.
de Kort, PLM
Mont'Alverne, F.J.
Carvalho, JJF
Lima, F.O.
de Araújo Rocha, F.
de Almeida Bandeira, D.
Freitas de Lucena, A.
Coelho Silva, H.
Martins, S.O.
Pontes-Neto, O.M.
Dias, F.A.
Abud, D.G.
Cerantola, R.
Camilo, M.
Alves, F.A.
Martins, R.K.
Nakiri, G.
Castro-Afonso, L.H.
Puetz, V.
Gerber, J.C.
Pallesen, L.P.
Barlinn, K.
Barlinn, J.
Siepmann, T.
Bodechtel, U.
Schneider, H.
Reichmann, H.
von Kummer, R.
Grählert, X.
Djawid, B.
Pfeiffer, R.
Audebert, H.J.
Nolte, C.H.
Erdur, H.
Scheitz, J.F.
Szabo, K.
Griebe, M.
Groden, C.
Berlis, A.
Maurer, C.
Ertl, M.
Zickler, P.
Schneider, C.
Rueckert, C.
Staudacher, T.
Mazighi, M.
Piotin, M.
Ben Maacha, M.
Blanc, R.
Desilles, J.P.
Redjem, H.
Escalard, S.
Smajda, S.
Ciccio, G.
Maier, B.
Devoye, F.
Herbert, S.
Zini, A.
Vallone, S.
Bigliardi, G.
Dell'Acqua, M.L.
Rosafio, F.
Verganti, L.
Zelent, G.
Maffei, S.
Michel, P.
Meyer, I.
Herzig, R.
Algra, A.
Audebert, H.
Pontes-Neto, O.M.
Lyden, P.
Hoffman, K.T.
Raman, R.
Toni, D.
Tanck, MWT
Yoo, A.J.
Pellikaan, W.
Bouyacoub, N.
Zweedijk, B.
de Meris, J.
Haase, K.
Simons, M.
Wittenberg, T.
Brade, K.
Bos, E.
Wojcieszek, D.
Greving, J.P.
Bredewoud, F.
Groupes de travail
BASICS Study Group
Liens vers les personnes
Liens vers les unités
ISSN
1533-4406
Statut éditorial
Publié
Date de publication
2021-05-20
Volume
384
Numéro
20
Première page
1910
Dernière page/numéro d’article
1920
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Résumé
The effectiveness of endovascular therapy in patients with stroke caused by basilar-artery occlusion has not been well studied.
We randomly assigned patients within 6 hours after the estimated time of onset of a stroke due to basilar-artery occlusion, in a 1:1 ratio, to receive endovascular therapy or standard medical care. The primary outcome was a favorable functional outcome, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 to 6, with 0 indicating no disability, 3 indicating moderate disability, and 6 indicating death) at 90 days. The primary safety outcomes were symptomatic intracranial hemorrhage within 3 days after the initiation of treatment and mortality at 90 days.
A total of 300 patients were enrolled (154 in the endovascular therapy group and 146 in the medical care group). Intravenous thrombolysis was used in 78.6% of the patients in the endovascular group and in 79.5% of those in the medical group. Endovascular treatment was initiated at a median of 4.4 hours after stroke onset. A favorable functional outcome occurred in 68 of 154 patients (44.2%) in the endovascular group and 55 of 146 patients (37.7%) in the medical care group (risk ratio, 1.18; 95% confidence interval [CI], 0.92 to 1.50). Symptomatic intracranial hemorrhage occurred in 4.5% of the patients after endovascular therapy and in 0.7% of those after medical therapy (risk ratio, 6.9; 95% CI, 0.9 to 53.0); mortality at 90 days was 38.3% and 43.2%, respectively (risk ratio, 0.87; 95% CI, 0.68 to 1.12).
Among patients with stroke from basilar-artery occlusion, endovascular therapy and medical therapy did not differ significantly with respect to a favorable functional outcome, but, as reflected by the wide confidence interval for the primary outcome, the results of this trial may not exclude a substantial benefit of endovascular therapy. Larger trials are needed to determine the efficacy and safety of endovascular therapy for basilar-artery occlusion. (Funded by the Dutch Heart Foundation and others; BASICS ClinicalTrials.gov number, NCT01717755; Netherlands Trial Register number, NL2500.).
We randomly assigned patients within 6 hours after the estimated time of onset of a stroke due to basilar-artery occlusion, in a 1:1 ratio, to receive endovascular therapy or standard medical care. The primary outcome was a favorable functional outcome, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 to 6, with 0 indicating no disability, 3 indicating moderate disability, and 6 indicating death) at 90 days. The primary safety outcomes were symptomatic intracranial hemorrhage within 3 days after the initiation of treatment and mortality at 90 days.
A total of 300 patients were enrolled (154 in the endovascular therapy group and 146 in the medical care group). Intravenous thrombolysis was used in 78.6% of the patients in the endovascular group and in 79.5% of those in the medical group. Endovascular treatment was initiated at a median of 4.4 hours after stroke onset. A favorable functional outcome occurred in 68 of 154 patients (44.2%) in the endovascular group and 55 of 146 patients (37.7%) in the medical care group (risk ratio, 1.18; 95% confidence interval [CI], 0.92 to 1.50). Symptomatic intracranial hemorrhage occurred in 4.5% of the patients after endovascular therapy and in 0.7% of those after medical therapy (risk ratio, 6.9; 95% CI, 0.9 to 53.0); mortality at 90 days was 38.3% and 43.2%, respectively (risk ratio, 0.87; 95% CI, 0.68 to 1.12).
Among patients with stroke from basilar-artery occlusion, endovascular therapy and medical therapy did not differ significantly with respect to a favorable functional outcome, but, as reflected by the wide confidence interval for the primary outcome, the results of this trial may not exclude a substantial benefit of endovascular therapy. Larger trials are needed to determine the efficacy and safety of endovascular therapy for basilar-artery occlusion. (Funded by the Dutch Heart Foundation and others; BASICS ClinicalTrials.gov number, NCT01717755; Netherlands Trial Register number, NL2500.).
Sujets
PID Serval
serval:BIB_798EF9447DEB
PMID
Date de création
2021-05-25T06:35:06.228Z
Date de création dans IRIS
2025-05-21T04:42:12Z