REBEL EM - By Salim Rezaie - June 21, 2021
Paper: Langezaal LCM et al. Endovascular Therapy for Stroke Due to Basilar-Artery Occlusion. NEJM 2021. PMID: 34010530[Access on Read by QxMD]
Clinical Question: In patients with acute basilar artery occlusion is favorable functional outcome at 90 days improved with endovascular therapy vs standard medical care?
Author Conclusion: “Among patients with stroke from basilar-artery occlusion, endovascular therapy and medical therapy did not differ significantly with respect to a favorable functional outcome, but as reflected by the wide confidence interval for the primary outcome, the results of this trial may not exclude a substantial benefit of endovascular therapy. Larger trials are needed to determine the efficacy and safety of endovascular therapy for basilar-artery occlusion.”
Clinical Take Home Point: In patients with basilar artery occlusion, endovascular therapy compared to medical therapy alone was not significantly different with respect to a favorable functional outcome. Although, benefit cannot be excluded based on this trial, a much larger trial would be needed to determine the efficacy and safety of endovascular therapy in these patients. Additionally, the use of advanced imaging (i.e CT perfusion) will most likely be needed to select the appropriate patients for endovascular therapy going forward.