Titre
Early Intubation in Endovascular Therapy for Basilar Artery Occlusion: A Post Hoc Analysis of the BASICS Trial.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Barlinn, K.
Auteure/Auteur
Langezaal, LCM
Auteure/Auteur
Dippel, DWJ
Auteure/Auteur
van Zwam, W.H.
Auteure/Auteur
Roessler, M.
Auteure/Auteur
Roos, YBWEM
Auteure/Auteur
Emmer, B.J.
Auteure/Auteur
van Oostenbrugge, R.J.
Auteure/Auteur
Gerber, J.C.
Auteure/Auteur
Yoo, A.J.
Auteure/Auteur
Pontes-Neto, O.M.
Auteure/Auteur
Mazighi, M.
Auteure/Auteur
Audebert, H.J.
Auteure/Auteur
Michel, P.
Auteure/Auteur
Schonewille, W.J.
Auteure/Auteur
Puetz, V.
Auteure/Auteur
Contributrices/contributeurs
Schonewille, W.J.
Vos, J.A.
van der Hoeven, EJRJ
van Leersum, M.
van den Heuvel, DAF
van Strijen, MJL
Teunissen, L.L.
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.
Staals, J.
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
de Araújo Rocha, F.
de Almeida Bandeira, D.
Freitas de Lucena, A.
Coelho Silva, H.
Martins, S.O.
Dias, F.A.
Abud, D.G.
Cerantola, R.
Camilo, M.
Alves, F.A.
Martins, R.K.
Nakiri, G.
Castro-Afonso, L.H.
Pallesen, L.P.
Barlinn, J.
Siepmann, T.
Nolte, C.H.
Erdur, H.
Scheitz, J.F.
Szabo, K.
Schneider, H.
Berlis, A.
Maurer, C.
Ertl, M.
Zickler, P.
Schneider, C.
Rueckert, C.
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.
Meyer, I.
Herzig, R.
Groupes de travail
BASICS Study Group
Liens vers les personnes
Liens vers les unités
ISSN
1524-4628
Statut éditorial
Publié
Date de publication
2023-11
Volume
54
Numéro
11
Première page
2745
Dernière page/numéro d’article
2754
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Randomized Controlled Trial ; Multicenter Study ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Résumé
The optimal anesthetic management for endovascular therapy (EVT) in patients with posterior circulation stroke remains unclear. Our objective was to investigate the impact of early intubation in patients enrolled in the BASICS trial (Basilar Artery International Cooperation Study).
BASICS was a multicenter, randomized, controlled trial that compared the efficacy of EVT compared with the best medical care alone in patients with basilar artery occlusion. In this post hoc analysis, early intubation within the first 24 hours of the estimated time of basilar artery occlusion was examined as an additional covariate using regression modeling. We estimated the adjusted relative risks (RRs) for favorable outcomes, defined as modified Rankin Scale scores of 0 to 3 at 90 days. An adjusted common odds ratio was estimated for a shift in the distribution of modified Rankin Scale scores at 90 days.
Of 300 patients in BASICS, 289 patients were eligible for analysis (151 in the EVT group and 138 in the best medical care group). compared with medical care alone, EVT was related to a higher risk of early intubation (RR, 1.29 [95% CI, 1.09-1.53]; P<0.01), and early intubation was negatively associated with favorable outcome (RR, 0.61 [95% CI, 0.45-0.84]; P=0.002). Whereas there was no overall treatment effect of EVT on favorable outcome (RR, 1.22 [95% CI, 0.95-1.55]; P=0.121), EVT was associated with favorable outcome (RR, 1.34 [95% CI, 1.05-1.71]; P=0.018) and a shift toward lower modified Rankin Scale scores (adjusted common odds ratio, 1.63 [95% CI, 1.04-2.57]; P=0.033) if adjusted for early intubation.
In this post hoc analysis of the neutral BASICS trial, early intubation was linked to unfavorable outcomes, which might mitigate a potential benefit from EVT by indirect effects due to an increased risk of early intubation. This relationship may be considered when assessing the efficacy of EVT in patients with basilar artery occlusion in future trials.
BASICS was a multicenter, randomized, controlled trial that compared the efficacy of EVT compared with the best medical care alone in patients with basilar artery occlusion. In this post hoc analysis, early intubation within the first 24 hours of the estimated time of basilar artery occlusion was examined as an additional covariate using regression modeling. We estimated the adjusted relative risks (RRs) for favorable outcomes, defined as modified Rankin Scale scores of 0 to 3 at 90 days. An adjusted common odds ratio was estimated for a shift in the distribution of modified Rankin Scale scores at 90 days.
Of 300 patients in BASICS, 289 patients were eligible for analysis (151 in the EVT group and 138 in the best medical care group). compared with medical care alone, EVT was related to a higher risk of early intubation (RR, 1.29 [95% CI, 1.09-1.53]; P<0.01), and early intubation was negatively associated with favorable outcome (RR, 0.61 [95% CI, 0.45-0.84]; P=0.002). Whereas there was no overall treatment effect of EVT on favorable outcome (RR, 1.22 [95% CI, 0.95-1.55]; P=0.121), EVT was associated with favorable outcome (RR, 1.34 [95% CI, 1.05-1.71]; P=0.018) and a shift toward lower modified Rankin Scale scores (adjusted common odds ratio, 1.63 [95% CI, 1.04-2.57]; P=0.033) if adjusted for early intubation.
In this post hoc analysis of the neutral BASICS trial, early intubation was linked to unfavorable outcomes, which might mitigate a potential benefit from EVT by indirect effects due to an increased risk of early intubation. This relationship may be considered when assessing the efficacy of EVT in patients with basilar artery occlusion in future trials.
PID Serval
serval:BIB_A864162B77C7
PMID
Date de création
2023-10-26T12:57:34.746Z
Date de création dans IRIS
2025-05-21T04:18:30Z