Early Intubation in Endovascular Therapy for Basilar Artery Occlusion: A Post Hoc Analysis of the BASICS Trial.
Details
Serval ID
serval:BIB_A864162B77C7
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Early Intubation in Endovascular Therapy for Basilar Artery Occlusion: A Post Hoc Analysis of the BASICS Trial.
Journal
Stroke
Working group(s)
BASICS Study Group
Contributor(s)
Schonewille W.J., Vos J.A., van der Hoeven EJRJ, van Leersum M., van den Heuvel DAF, van Strijen MJL, Teunissen L.L., van der Lugt A., van Es ACGM, van Doormaal P.J., Kappelle L.J., Lo T.H., van der Worp H.B., Boiten J., Lycklama À Nijeholt G.J., Nederkoorn P.J., Majoie CBLM, Coutinho J., Staals J., Hofmeijer J., Martens J., Bernsen M.L., Wermer MJH, van Walderveen MAA, Remmers MJM, de Laat K.F., de Kort PLM, Mont'Alverne F.J., Carvalho JJF, de Araújo Rocha F., de Almeida Bandeira D., Freitas de Lucena A., Coelho Silva H., Martins S.O., Dias F.A., Abud D.G., Cerantola R., Camilo M., Alves F.A., Martins R.K., Nakiri G., Castro-Afonso L.H., Pallesen L.P., Barlinn J., Siepmann T., Nolte C.H., Erdur H., Scheitz J.F., Szabo K., Schneider H., Berlis A., Maurer C., Ertl M., Zickler P., Schneider C., Rueckert C., Piotin M., Ben Maacha M., Blanc R., Desilles J.P., Redjem H., Escalard S., Smajda S., Ciccio G., Maier B., Devoye F., Herbert S., Zini A., Vallone S., Bigliardi G., Dell'Acqua M.L., Rosafio F., Verganti L., Zelent G., Maffei S., Meyer I., Herzig R.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
11/2023
Peer-reviewed
Oui
Volume
54
Number
11
Pages
2745-2754
Language
english
Notes
Publication types: Randomized Controlled Trial ; Multicenter Study ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
The optimal anesthetic management for endovascular therapy (EVT) in patients with posterior circulation stroke remains unclear. Our objective was to investigate the impact of early intubation in patients enrolled in the BASICS trial (Basilar Artery International Cooperation Study).
BASICS was a multicenter, randomized, controlled trial that compared the efficacy of EVT compared with the best medical care alone in patients with basilar artery occlusion. In this post hoc analysis, early intubation within the first 24 hours of the estimated time of basilar artery occlusion was examined as an additional covariate using regression modeling. We estimated the adjusted relative risks (RRs) for favorable outcomes, defined as modified Rankin Scale scores of 0 to 3 at 90 days. An adjusted common odds ratio was estimated for a shift in the distribution of modified Rankin Scale scores at 90 days.
Of 300 patients in BASICS, 289 patients were eligible for analysis (151 in the EVT group and 138 in the best medical care group). compared with medical care alone, EVT was related to a higher risk of early intubation (RR, 1.29 [95% CI, 1.09-1.53]; P<0.01), and early intubation was negatively associated with favorable outcome (RR, 0.61 [95% CI, 0.45-0.84]; P=0.002). Whereas there was no overall treatment effect of EVT on favorable outcome (RR, 1.22 [95% CI, 0.95-1.55]; P=0.121), EVT was associated with favorable outcome (RR, 1.34 [95% CI, 1.05-1.71]; P=0.018) and a shift toward lower modified Rankin Scale scores (adjusted common odds ratio, 1.63 [95% CI, 1.04-2.57]; P=0.033) if adjusted for early intubation.
In this post hoc analysis of the neutral BASICS trial, early intubation was linked to unfavorable outcomes, which might mitigate a potential benefit from EVT by indirect effects due to an increased risk of early intubation. This relationship may be considered when assessing the efficacy of EVT in patients with basilar artery occlusion in future trials.
BASICS was a multicenter, randomized, controlled trial that compared the efficacy of EVT compared with the best medical care alone in patients with basilar artery occlusion. In this post hoc analysis, early intubation within the first 24 hours of the estimated time of basilar artery occlusion was examined as an additional covariate using regression modeling. We estimated the adjusted relative risks (RRs) for favorable outcomes, defined as modified Rankin Scale scores of 0 to 3 at 90 days. An adjusted common odds ratio was estimated for a shift in the distribution of modified Rankin Scale scores at 90 days.
Of 300 patients in BASICS, 289 patients were eligible for analysis (151 in the EVT group and 138 in the best medical care group). compared with medical care alone, EVT was related to a higher risk of early intubation (RR, 1.29 [95% CI, 1.09-1.53]; P<0.01), and early intubation was negatively associated with favorable outcome (RR, 0.61 [95% CI, 0.45-0.84]; P=0.002). Whereas there was no overall treatment effect of EVT on favorable outcome (RR, 1.22 [95% CI, 0.95-1.55]; P=0.121), EVT was associated with favorable outcome (RR, 1.34 [95% CI, 1.05-1.71]; P=0.018) and a shift toward lower modified Rankin Scale scores (adjusted common odds ratio, 1.63 [95% CI, 1.04-2.57]; P=0.033) if adjusted for early intubation.
In this post hoc analysis of the neutral BASICS trial, early intubation was linked to unfavorable outcomes, which might mitigate a potential benefit from EVT by indirect effects due to an increased risk of early intubation. This relationship may be considered when assessing the efficacy of EVT in patients with basilar artery occlusion in future trials.
Keywords
Humans, Basilar Artery/surgery, Stroke/therapy, Arterial Occlusive Diseases/surgery, Endovascular Procedures/adverse effects, Intubation, Intratracheal, Treatment Outcome, Thrombectomy, anesthetics, basilar artery ischemia, intubation, ischemic stroke, treatment effectiveness
Pubmed
Web of science
Create date
26/10/2023 14:57
Last modification date
20/01/2024 8:12
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