- Design
- Post hoc analysis of a randomised trial (ATTENTION)
- Population
- 340 patients with acute basilar artery occlusion (277 CT, 63 MRI at baseline)
- Primary outcome
- Modified Rankin score 0–3 at 90 days
- Effect
- OR 0.99 (95% CI 0.50–1.95) MRI vs CT; no significant workflow delay
ATTENTION randomised patients with acute basilar artery occlusion to thrombectomy or best medical care. This post hoc analysis compared patients whose baseline imaging was CT (277) or MRI (63).
The odds of a modified Rankin score of 0–3 at 90 days were the same (OR 0.99, 95% CI 0.50–1.95), in both treatment arms and across time windows. MRI did not significantly lengthen onset-to-randomisation or onset-to-puncture times.
Imaging was not randomised — clinicians chose MRI for reasons the analysis cannot fully see — and the MRI group was small. But there is no signal that waiting for MRI improves selection.
In practice: where MRI is not available around the clock, as in most Indian centres, CT with CT angiography is enough to select patients for basilar thrombectomy. Do not delay transfer or treatment to obtain MRI.
- Use CT with CT angiography as the first-line imaging for suspected basilar occlusion.
- Avoid delaying thrombectomy or transfer to obtain MRI.
- Use MRI where it is immediately available and does not slow the pathway.
- Report posterior circulation ischaemic changes on CT using a structured score such as pc-ASPECTS.
Why it matters
It removes a reason to delay treatment in centres where MRI is not immediately available.
Don't overread it
Imaging was not randomised and only 63 patients had MRI, so a modest difference cannot be excluded.
The statistics, in plain English
An odds ratio of 0.99 means no difference, but the interval from 0.50 to 1.95 is wide enough to fit either a halving or a near-doubling of the odds of a good outcome.
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