Basilar Artery Occlusion Chinese Endovascular - BAOCHE

Oct 24, 2022
Font Size
A
A
A
Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Chinese National Ministry of Science and Technology
Date Published:
10/12/2022
Original Posted Date:
10/24/2022
References

Contribution To Literature:

The BAOCHE trial showed that thrombectomy improved functional status; however, it resulted in more intracranial hemorrhage.

Description:

The goal of the trial was to evaluate thrombectomy compared with medical therapy among patients with acute stroke due to basilar artery occlusion.

Study Design

  • Randomization
  • Parallel

Patients with acute stroke due to basilar artery occlusion were randomized to thrombectomy (n = 110) vs. medical therapy alone (n = 107). Patients could receive intravenous thrombolysis according to provider discretion.

  • Total number of enrollees: 217
  • Duration of follow-up: 90 days
  • Mean patient age: 64 years
  • Percentage female: 27%
  • Percentage with diabetes: 27%

Inclusion criteria:

  • Patients 18-80 years of age with stroke due to acute basilar artery occlusion
  • Symptom onset within the prior 6-24 hours
  • Pre-stroke score of 0 or 1 on the modified Rankin scale score

Exclusion criteria:

  • Intracranial hemorrhage
  • Large infarct in the posterior circulation

Other salient features/characteristics:

  • Thrombolysis was used in 14% of the thrombectomy group vs. 21% of the control group

Principal Findings:

The primary outcome, good functional status (modified Rankin scale score 0 to 3) at 90 days, occurred in 46% of the thrombectomy group vs. 24% of the medical therapy group (p < 0.001).

Secondary outcomes:

  • Mortality at 90 days: 31% in the thrombectomy group vs. 42% in the medical therapy group (p = not significant [NS])
  • Symptomatic intracranial hemorrhage: 6% in the thrombectomy group vs. 1% in the medical therapy group (p = NS)
  • Procedural complications: 11% in the thrombectomy group

Interpretation:

Among patients with acute stroke due to basilar artery occlusion, thrombectomy was associated with improvement in good functional status. However, thrombectomy was also associated with increased symptomatic intracranial hemorrhage and procedural complications. Mortality was similar between the treatment groups.

References:

Jovin TG, Li C, Wu L, et al., on behalf of BAOCHE Investigators. Trial of Thrombectomy 6 to 24 Hours After Stroke due to Basilar-Artery Occlusion. N Engl J Med 2022;387:1373-84.

Editorial: Schonewille WJ. Favorable Outcomes in Endovascular Therapy for Basilar-Artery Occlusion. N Engl J Med 2022;387:1428-9.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias

Keywords: Basilar Artery, Coronary Occlusion, Endovascular Procedures, Functional Status, Infarction, Intracranial Hemorrhages, Secondary Prevention, Stroke, Thrombectomy, Thrombolytic Therapy, Vascular Diseases


< Back to Listings