Outcomes of Mechanical Thrombectomy in Patients With Acute Basilar Artery Occlusion With Mild to Moderate Symptoms
Ettore Nicolini, Giovanni Pracucci, Antonio Ciacciarelli, Valentina Saia, Nicola Limbucci, Patrizia Nencini, Maria Ruggiero, Marco Longoni, Mirco Cosottini, Giovanni Orlandi, Mauro Bergui, Paolo Cerrato, Stefano Vallone, Guido Bigliardi, Samuele Cioni, Rossana Tassi, Valerio Da Ros, Marina Diomedi, L. Simonetti, Andrea Zini, Mariano Velo, Paolino La Spina, Lucio Castellan, Massimo Del Sette, Manuela De Michele, Svetlana Lorenzano, Ilaria Casetta, Enrico Fainardi, Fabrizio Sallustio, R. Menozzi, Alessandro Pezzini, Daniele Giuseppe Romano, Giulia Frauenfelder, Sergio Nappini, Nicola Davide Loizzo, Andrea Saletti, Alessandro De Vito, Raffaele Augelli, Manuel Cappellari, Domenico Sergio Zimatore, Marco Petruzzellis, Luca Allegretti, Tiziana Tassinari, Daniele Ajello, Simona Marcheselli, Maria Porzia Ganimede, Giovanni Boero, Salvatore Mangiafico, Niaz Ahmed, Danilo Toni, Carlo W. Cereda, for the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) and SITS-ISTR
Abstract
BACKGROUND AND OBJECTIVES: The benefit of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) with basilar artery occlusion (BAO) and a baseline National Institute of Health Stroke Scale (NIHSS) score <10 is unclear because this subpopulation has been substantially excluded from large clinical trials. The aim of our study was to determine whether MT ± IV thrombolysis (IVT) improves functional outcomes compared with IVT alone in patients with BAO and a NIHSS score <10. METHODS: We emulated a hypothetical trial including adult patients with BAO, a baseline NIHSS score <10, and prestroke modified Rankin scale (mRS) scores 0-2, comparing MT (±IVT) with IVT alone. We acquired data from patients receiving MT (±IVT) within 24 hours of onset from the Italian Registry of Endovascular Treatment in Acute Stroke and data from patients treated only with IVT within 9 hours of symptom onset from the SITS International Stroke Thrombolysis Register, from 2011 until 2021. We used inverse probability weighting (IPW) adjusted for prespecified covariates to weight each individual's contribution to the outcome. The primary outcome was 90-day mRS scores 0-2. Secondary outcomes included 90-day mRS scores 0-1, 90-day mRS scores 4-5, mortality at 90 days, in-hospital death, and symptomatic intracerebral hemorrhage. RESULTS: for interaction 0.02). DISCUSSION: In a large-scale target trial emulation on patients with stroke from BAO and a NIHSS score <10, MT was associated with better functional outcomes compared with IVT alone. Further research is needed to confirm the benefit of MT in patients with a NIHSS score <6. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that MT ± intravenous thrombolysis is associated with better 90-day functional outcomes in patients with BAO and a NIHSS score < 10 compared with intravenous thrombolysis alone.