CT was as good as MRI for selecting basilar occlusion patients

Design

Post hoc analysis of a randomised trial (ATTENTION)

Population

340 patients with acute basilar artery occlusion, China

Primary outcome

Modified Rankin 0–3 at 90 days

Effect

MRI vs CT OR 0.99 (95% CI 0.50–1.95)

This post hoc analysis of the Chinese ATTENTION trial compared outcomes by baseline imaging in 340 patients with acute basilar artery occlusion: 277 imaged with CT and 63 with MRI.

Imaging modality was not associated with good 90-day outcome (modified Rankin 0–3; OR 0.99, 95% CI 0.50–1.95), and the result was consistent in both the thrombectomy and medical arms and across time windows. MRI did not significantly delay randomisation or groin puncture.

The groups were not randomised and the MRI group was small, so this is reassurance rather than proof. Practically, it supports using whatever imaging is fastest — usually CT with CT angiography in Indian stroke centres — rather than waiting for MRI.

• Use CT with CT angiography to select basilar occlusion patients when it is the fastest option.
• Do not delay thrombectomy referral to obtain MRI.
• Use MRI where it is immediately available and does not slow the pathway.
• Keep a high index of suspicion for basilar occlusion in sudden coma, quadriparesis or crossed signs.

Why it matters

Many centres lack round-the-clock MRI, and this suggests patients are not disadvantaged by CT-based selection.

Don't overread it

This is a non-randomised comparison within a trial, with only 63 MRI patients.

The statistics, in plain English

An OR of 0.99 suggests no difference, but the interval from 0.50 to 1.95 is wide — a meaningful difference in either direction cannot be ruled out with this sample.

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