TY - JOUR
T1 - Early Intubation in Endovascular Therapy for Basilar Artery Occlusion
T2 - A Post Hoc Analysis of the BASICS Trial
AU - Barlinn, Kristian
AU - Langezaal, Lucianne C. M.
AU - Dippel, Diederik W. J.
AU - van, Wim H.
AU - Roessler, Martin
AU - Roos, Yvo B. W. E. M.
AU - Emmer, Bart J.
AU - van Oostenbrugge, Robert J.
AU - Gerber, Johannes C.
AU - Yoo, Albert J.
AU - Pontes-Neto, Octavio M.
AU - Mazighi, Mikael
AU - Audebert, Heinrich J.
AU - Michel, Patrik
AU - BASICS Study Group
AU - Schonewille, Wouter J.
AU - Puetz, Volker
N1 - Funding Information: The BASICS trial (Basilar Artery International Cooperation Study) was funded by the Dutch Heart Foundation, the Swiss Heart Foundation, the São Paulo Research Foundation, the National Council for Scientific and Technological Development in Brazil, the University Medical Center Utrecht, and St. Antonius Hospital Nieuwegein. Publisher Copyright: © 2023 American Heart Association, Inc.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
AB - BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
KW - anesthetics
KW - basilar artery ischemia
KW - intubation
KW - ischemic stroke
KW - treatment effectiveness
UR - http://www.scopus.com/inward/record.url?scp=85175444389&partnerID=8YFLogxK
U2 - https://doi.org/10.1161/STROKEAHA.123.043669
DO - https://doi.org/10.1161/STROKEAHA.123.043669
M3 - Article
C2 - 37871243
SN - 0039-2499
VL - 54
SP - 2745
EP - 2754
JO - Stroke
JF - Stroke
IS - 11
ER -