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Original research
Thrombectomy versus combined thrombolysis for acute basilar artery occlusion: a secondary analysis of the ATTENTION trial
  1. Bin Han1,
  2. Raynald2,
  3. Yaxin Wu3,
  4. Ganghua Feng3,
  5. Xuehan Liu4,
  6. Peng Zhang3,
  7. Pengyu Lu3,
  8. Yi Liu3,
  9. Wei Hu5,
  10. Yaxuan Sun3
    1. 1 Shanxi Key Laboratory of Brain Disease Control, Department of Neurology, Shanxi Provincial People’s Hospital, Taiyuan, China
    2. 2 Beijing Tiantan Hospital Department of Interventional Neuroradiology, Beijing, China
    3. 3 Department of Neurology, Shanxi Provincial People’s Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
    4. 4 The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei, China
    5. 5 Department of Neurology, University of Science and Technology of China, Hefei, China
    1. Correspondence to Professor Yaxuan Sun, The Department of Neurology, Shanxi Provincial People's Hospital,Shanxi Medical University, Taiyuan, Shanxi, China; yaxuansjjr{at}; Professor Wei Hu; andinghu{at}


    Background Few studies have compared the outcomes of bridging intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) with those of direct MT in patients with acute basilar artery occlusion (BAO). This study aimed to assess the efficacy and safety of direct endovascular treatment (EVT) and bridging IVT followed by EVT in Chinese patients with acute basilar artery occlusion BAO.

    Methods This subanalysis derived from the prospective multicenter randomized controlled trial of the ATTENTION study, included 221 patients with acute BAO categorized into two groups based on whether they received bridging IVT before MT: MT alone or combined IVT+MT. The primary endpoint was the modified Rankin Scale (mRS) score distribution at 90 days. Secondary outcomes included mRS scores within different ranges (0–1, 0–2, and 0–3) at the 90-day point and National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours and 3 days post-intervention. Safety outcomes encompassed intracranial hemorrhage incidence based on the Heidelberg classification criteria (any intracerebral hemorrhage) and mortality assessment at 90 days.

    Results Direct and bridging IVT before EVT yielded similar primary outcomes. No significant difference in 90-day mRS scores (median, 4.5 vs 4; adjusted odds ratio (aOR), 0.95 [95% confidence interval (CI), 0.79 to 1.15]; p=0.624) was observed between the two groups. Regarding safety outcomes, no significant differences were observed between the groups in terms of death within 90 days or any intracranial hemorrhage within 24 hours.

    Conclusions In patients with acute BAO, those treated with bridging IVT before EVT did not demonstrate any advantages in enhanced safety and efficacy outcomes compared with those treated with direct EVT.

    • Thrombolysis
    • Stroke
    • Thrombectomy

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    • BH and YW are joint first authors.

    • WH and YS contributed equally.

    • Contributors BH, R, WH and YS: conceptualization, data collection, analysis, drafting original manuscript. BH, YW, GF, XL, PZ, PL, YL: data collection. BH, R, WH and YS: oversight, revising original manuscript. BH, WH and YS is the guarantor for this work and accepts responsibility for the data presented.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.