
Published in the New England Journal of Medicine (2022), the ATTENTION Trial is a landmark study exploring the efficacy and safety of endovascular treatment (EVT) for patients with acute basilar artery occlusion (BAO). Here’s an in-depth look at the findings and implications for clinical practice.
Objective
The trial aimed to assess whether EVT, in addition to best medical management (BMM), improves functional outcomes compared to BMM alone. It focused on patients with BAO confirmed via advanced imaging (CTA/MRA/DSA).
Key Details
- Study Design: Multicenter, prospective, randomized controlled trial
- Participants: 340 patients
- Thrombectomy Group: 226 patients
- Control Group: 114 patients
- Inclusion Criteria:
- Age ≥ 18 years
- Ischemic symptoms in the basilar artery territory
- NIHSS score ≥10
- Symptom onset within 12 hours prior to randomization
Primary Outcome
The trial’s primary measure of success was achieving good functional status at 90 days, defined by a modified Rankin Scale (mRS) score of ≤3.
- Thrombectomy Group: 46%
- Control Group: 23%
Adjusted Rate Ratio: 2.06 (95% CI: 1.46–2.91, P < 0.001)
Secondary Outcomes
- Symptomatic Intracranial Hemorrhage:
- Occurred in 5% of the thrombectomy group.
- Data not reported for the control group.
- Mortality at 90 Days:
- Thrombectomy Group: 37%
- Control Group: 55%
Adjusted Risk Ratio: 0.66 (95% CI: 0.52–0.82)
Conclusion
The trial concluded that EVT significantly improves functional outcomes in patients with BAO, with a twofold higher likelihood of achieving good function at 90 days compared to BMM alone. However, EVT was associated with a higher risk of symptomatic intracranial hemorrhage. Mortality rates were notably lower in the thrombectomy group.
Clinical Implications
For clinicians managing acute ischemic stroke with basilar artery occlusion, the ATTENTION Trial provides robust evidence supporting the use of EVT as a first-line treatment, particularly when initiated within 12 hours of symptom onset. While the benefits in functional outcomes are clear, careful patient selection and management are essential to mitigate procedural risks.
Reference:
Tao C et al. “Endovascular Treatment for Acute Basilar-Artery Occlusion.” N Engl J Med. 2022;387:1361-1372.