Endovascular Therapy for Stroke Due to Basilar-Artery Occlus
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The effectiveness of endovascular therapy in patients with stroke caused by basilar-artery occlusion has not been well studied.

Researchers 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.

Results:
-- 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.

-- Symptomatic intracranial hemorrhage occurred in 4.5% of the patients after endovascular therapy and in 0.7% of those after medical therapy; mortality at 90 days was 38.3% and 43.2%, respectively.

Conclusively, 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.

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2030297?rss=searchAndBrowse
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