Remedial angioplasty or stenting for acute basilar artery occlusion: A Post Hoc Analysis of the ATTENTION Trial

BACKGROUNDWhether remedial angioplasty or stenting (RAS) improves clinical outcomes of patients with basilar artery occlusion (BAO) undergoing endovascular treatment (EVT) is controversial. This study aimed to investigate the impact of RAS on prognosis in acute BAO. METHODSThis post-hoc analysis derived from the ATTENTION study. Patients undergoing EVT were categorized in the RAS group if they received balloon angioplasty, stent implantation, or balloon plus stenting. The primary outcome was favorable outcome (modified Rankin Scale score of 0-3) at 90 days. Safety outcomes included death within 90 days and any intracranial hemorrhage within 24 h. Control of confounders using inverse probability processing weighting (IPTW). RESULTSA total of 221 patients with BAO experiencing EVT were included, of whom 104 (47.06%) received RAS. Multivariate analysis by IPTW adjustment showed that there was no significant difference in favorable outcome between the two groups (OR, 0.81, 95% CI, 0.55, 1.19; P=0.282). But RAS was associated with decreased risk of excellent outcome (OR, 0.67; 95% CI, 0.45-0.98; P=0.042) and functional independence (OR, 0.64; 95% CI, 0.42-0.98; P=0.043). Regarding safety outcomes, the RAS group had a significantly lower incidence of any intracranial hemorrhage within 24 h (OR, 0.52; 95% CI, 0.28-0.92; P=0.027). However, there was little difference in 90-day mortality between the two groups. In non-atherosclerotic populations, RAS is usually associated with a worse clinical prognosis; however, this phenomenon has not been found in atherosclerotic populations (all P<0.05 for the stroke etiologyxRAS interaction). In RAS patients, we find that there was no difference in functional or safety outcomes between only balloon angioplasty (52 patients) compared with other remedy group (52 patients). CONCLUSIONSDespite the fact that RAS is secure, it didnt further improve favorable outcomes of patients with BAO undergoing EVT; particularly in the non-atherosclerotic population. In patients with RAS, balloon angioplasty alone is an appropriate remedial technique, additional stent implantation may not be required.