Neurology: Zhejiang University: bilateral basal ganglia arteries are blocked, the earlier the treatment, the better the effect

Basilar artery occlusion (BAO) has a high morbidity and mortality rate without recanalization1
.
More and more evidence from prospective or retrospective cohorts from multiple centers suggests that endovascular therapy (EVT) is beneficial for BAO patients

Onset to puncture time (OPT) is considered to provide a practical and useful clinical marker of EVT
.
Evidence from acute anterior large vessel occlusion suggests that there is a strong time dependence for early EVT

However, current data investigating the relationship between OPT and BAO patient outcomes are limited and inconsistent
.
Some studies have shown that OPT has no relationship with the prognosis of acute BAO, while other studies have shown that treatment time is critical for patients with acute BAO

However, in daily practice, interventionists generally use a longer time window to perform EVT on acute BAO, although this has not been fully determined
.
In order to guide the further improvement of EVT in acute BAO, more evidence on the relationship between OPT and prognosis is needed

In this way, Hongfei Sang and others of Zhejiang University used data from the BASILAR Endovascular Treatment Study for Acute Basilar Artery Occlusion (BASILAR) to evaluate how OPT affects the efficacy and safety of EVT in patients with acute BAO in current clinical practice
.
And study the benefit degree of EVT changes with the delay of treatment time

They used the EVT study of acute basilar artery occlusion (BASILAR) to identify consecutive patients with acute basilar artery occlusion who received EVT at 47 comprehensive stroke centers in China from January 2014 to May 2019
.
The main result is a good functional result after 90 days (defined as a modified Rankin scale score [mRS] 0-3)

They found that among the 639 eligible patients, the median age was 65 years and the median OPT was 328 minutes (interquartile range, 220-490)
.
Compared with treatment within 4-8 hours, treatment within 4-8 hours and 8-12 hours was associated with a lower rate of favorable outcomes (adjusted OR values ​​were 0.

Restricted cubic spline regression analysis shows that OPT has an L-shaped correlation with favorable results (P nonlinearity=0.
028) and functional independence (P nonlinearity=0.
025), and there is a significant loss of profit throughout the first 9 hours, but then appears Relatively flat
.

The mortality rate of OPT increased relatively within 9 hours, but then leveled off (P ​​non-linearity = 0.
042)
.
The association between symptomatic intracerebral hemorrhage and OPT is not significant

The important significance of this study lies in the discovery: in patients with conventional acute basilar artery occlusion, early EVT treatment is associated with a better prognosis within the first 9 hours after the onset, but the subsequent benefits may remain unchanged
.

Original source:
Sang H fei, Yuan J jie, Qiu Z, et al.
Association Between Time to Endovascular Therapy and Outcomes in Patients With Acute Basilar Artery Occlusion .
Neurology.
Published online October 14, 2021:10.
1212/WNL.
0000000000012858.
doi: 10.
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0000000000012858