Endovascular treatment of acute basilar artery occlusion in patients with and without atrial fibrillation: results from the ATTENTION registry

Shuo Feng; Tong Li; Yingchun Wu; Hongchao Shi; Yongchang Liu; Bo Xu; Chenghua Xu; Qingqing Zhou; Fengling Qu; Rui Li; Chunrong Tao; Wen Sun; Wei Hu; Xinfeng Liu

doi:10.1177/17562864231159438

Endovascular treatment of acute basilar artery occlusion in patients with and without atrial fibrillation: results from the ATTENTION registry

Ther Adv Neurol Disord. 2023 Apr 19:16:17562864231159438. doi: 10.1177/17562864231159438. eCollection 2023.

Authors

Shuo Feng¹, Tong Li², Yingchun Wu³, Hongchao Shi⁴, Yongchang Liu⁵, Bo Xu⁶, Chenghua Xu⁷, Qingqing Zhou¹, Fengling Qu¹, Rui Li¹, Chunrong Tao¹, Wen Sun⁸, Wei Hu⁸, Xinfeng Liu⁸

Affiliations

¹ Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
² Department of Neurology, The Second People's Hospital of Nanning, Nanning, China.
³ Department of Neurology, ORDOS Central Hospital, Ordos, China.
⁴ Department of Neurology, Nanjing First Hospital, Nanjing, China.
⁵ Department of Neurovascular Intervention, Cangzhou Central Hospital, Cangzhou, China.
⁶ Department of Neurology, Affiliated Qingdao Central Hospital, Qingdao University, Qingdao, China.
⁷ Department of Neurology, Taizhou First People's Hospital, Taizhou, China.
⁸ Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China.

Abstract

Background: Previous studies have shown a potential beneficial effect of endovascular therapy (EVT) in patients with acute basilar artery occlusion (BAO). It was unclear that whether atrial fibrillation (AF) can affect the clinical outcomes for BAO patients treated with EVT.

Objectives: To investigate the association between AF and clinical outcomes, and whether AF can modify the efficacy and safety of EVT in patients with BAO.

Design: We conducted a multicenter, nationwide, retrospective analysis to investigate how the presence of AF affects treatment allocation for BAO patients.

Methods: The endovascular treatment for acute basilar artery occlusion (ATTENTION) registry was a multicenter, prospective study in China that included acute BAO patients who underwent EVT or received best medical management (BMM) between 2017 and 2021. The outcomes include the distribution of 3-month modified Rankin scale (mRS) score, functional independence (defined as mRS 0-3), symptomatic intracerebral hemorrhage, and mortality.

Results: 2134 patients were included in the study, of which 619 had AF and 1515 did not have AF. The median age was 65 (interquartile range [IQR]: 56-73) years, and 689 (32.3%) patients were female. Multivariate regression analysis indicated no significant association existed between AF and the distribution of mRS (adjusted common odds ratio, 1.05 [95% CI: 0.88, 1.25]; p = 0.564) at 90 days. Similarly, AF was not found to have a significant association with and other measured outcomes, or with the effects of EVT in AF subgroups for at 90 days as measured by ordinal mRS (p for heterogeneity = 0.247). Finally, no significant differences were found for symptomatic intracerebral hemorrhage and mortality within 90 days between the EVT and BMM groups across AF subgroups.

Conclusions: Our results illustrated that the effect of EVT did not differ statistically in acute ischemic stroke patients with and without AF. Moreover, no significant association between AF and functional or safety outcomes could be detected at 90 days.

Keywords: atrial fibrillation; basilar artery occlusion; clinical outcomes; endovascular treatment.