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Intravenous thrombolysis versus endovascular thrombectomy in acute basilar artery occlusion—A multicenter cohort study

2025-10Artigo científico Acesso aberto
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dc.contributor.authorRäty, Silja
dc.contributor.authorStrambo, Davide
dc.contributor.authorRäty, Silja
dc.contributor.authorGomez-Exposito, Alexandra
dc.contributor.authorMarto, João Pedro
dc.contributor.authorStrambo, Davide
dc.contributor.authorRamos, João Nuno
dc.contributor.authorKrebs, Stefan
dc.contributor.authorVirtanen, Pekka
dc.contributor.authorMarto, João Pedro
dc.contributor.authorRitvonen, Juhani
dc.contributor.authorAbdalkader, Mohamad
dc.contributor.authorRamos, João Nuno
dc.contributor.authorKlein, Piers
dc.contributor.authorSairanen, Tiina
dc.contributor.authorSykora, Marek
dc.contributor.authorVirtanen, Pekka
dc.contributor.authorLindsberg, Perttu J.
dc.contributor.authorPoli, Sven
dc.contributor.authorMichel, Patrik
dc.contributor.authorNguyen, Thanh N.
dc.contributor.authorKlein, Piers
dc.contributor.authorStrbian, Daniel
dc.contributor.authorSairanen, Tiina
dc.contributor.authorSykora, Marek
dc.contributor.authorLindsberg, Perttu
dc.contributor.authorPoli, Sven
dc.contributor.authorMichel, Patrik
dc.contributor.authorNguyen, Thanh
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblBlackwell Publishing Ltd
dc.date.accessioned2025-06-25T21:18:08Z
dc.date.available2025-06-25T21:18:08Z
dc.date.issued2025-10
dc.descriptionFunding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was supported by Helsinki University Hospital governmental subsidiary funds for clinical research (S.R., P.J.L., D.Strbian). Publisher Copyright: © 2025 World Stroke Organization.
dc.description.abstractBackground: Randomized controlled trials have demonstrated an improved outcome of basilar artery occlusion (BAO) with endovascular thrombectomy (EVT) compared to best medical treatment. However, a minority of the patients recruited up to 12–24 h from onset in the positive trials received intravenous thrombolysis (IVT), and a trial with a higher IVT rate did not show superiority of EVT. Thus, the efficacy and safety of EVT compared to IVT for BAO remain less clear. Aims: We aimed to compare outcomes after IVT alone to EVT with or without IVT for acute BAO. Methods: This international, observational, retrospective study included patients who received recanalization therapy for BAO at six centers between January 2010 and March 2024. The primary outcome was 3-month modified Rankin Scale (mRS) score 0–3, and secondary outcomes comprised mRS 0–2, ordinal mRS, mortality, and symptomatic intracranial hemorrhage. Outcomes after IVT versus EVT ± IVT were compared using inverse probability-weighted regression adjustment models adjusting for known predictors of outcome in BAO and baseline variables differing between the treatment groups. Interaction of the treatment group with symptom severity and onset-to-treatment time was tested. Results: Of 523 patients with BAO (median age 69, 35.2% women), 28.9% received IVT and 71.1% EVT ± IVT. The IVT-alone group had a lower baseline National Institutes of Health Stroke Scale score (median 11 vs 15) but equally extensive ischemic changes in baseline imaging. After inverse probability-weighted regression adjustment, the IVT-alone group had higher odds of mRS 0–3 (adjusted odds ratio (aOR) = 2.33 [95% confidence interval (CI) = 1.31–4.12]), mRS 0–2 (aOR = 1.93 [95% CI = 1.12–3.30]), lower median mRS (aOR = 1.81 [95% CI = 1.21–2.71]), and lower mortality (aOR = 0.53 [95% CI = 0.29–0.97]), but no difference in symptomatic intracranial hemorrhage (aOR = 0.81 [95% CI = 0.28–2.36]). No interactions for the primary outcome were found. Conclusion: In this study, patients with BAO had better outcome after IVT than EVT ± IVT independent of symptom severity and time from onset. Although the non-randomized design of the study warrants caution, the results encourage further trials comparing EVT and IVT to guide recanalization therapy in BAO patients. Data access statement: Anonymized data are available upon reasonable request to the corresponding author following the national legislation.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent904348
dc.identifier.doi10.1177/17474930251344451
dc.identifier.issn1747-4930
dc.identifier.otherPURE: 119468354
dc.identifier.otherPURE UUID: 3faf471f-a5b8-46fa-b307-257d80e6e6e1
dc.identifier.otherScopus: 105008080397
dc.identifier.otherPubMed: 40356017
dc.identifier.urihttp://hdl.handle.net/10362/184476
dc.identifier.urlhttps://www.scopus.com/pages/publications/105008080397
dc.language.isoeng
dc.peerreviewedyes
dc.subjectBasilar artery occlusion
dc.subjectendovascular thrombectomy
dc.subjectintravenous thrombolysis
dc.subjectNeurology
dc.subjectClinical Neurology
dc.titleIntravenous thrombolysis versus endovascular thrombectomy in acute basilar artery occlusion—A multicenter cohort studyen
dc.typejournal article
degois.publication.firstPage1114
degois.publication.issue9
degois.publication.lastPage1122
degois.publication.titleInternational Journal Of Stroke
degois.publication.volume20
dspace.entity.typePublication
person.familyNameRäty
person.familyNameStrambo
person.familyNamede Seabra Marto
person.familyNameRamos
person.familyNameVirtanen
person.familyNameKlein
person.familyNameSairanen
person.familyNameSykora
person.familyNameLindsberg
person.familyNamePoli
person.familyNameMichel
person.familyNameNguyen
person.givenNameSilja
person.givenNameDavide
person.givenNameJoão Pedro
person.givenNameJoao
person.givenNamePekka
person.givenNamePiers
person.givenNameTiina
person.givenNameMarek
person.givenNamePerttu
person.givenNameSven
person.givenNamePatrik
person.givenNameThanh
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person.identifier.ridACY-0995-2022
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person.identifier.scopus-author-id6603303767
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rcaap.rightsopenAccess
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