Recanalization is the Key for Better Outcome of Thrombectomy in Basilar Artery Occlusion

Patients with basilar artery occlusion (BAO) were excluded from previous randomized controlled trials (RCTs) of endovascular treatment (ET) for acute ischemic stroke, but are commonly treated in clinical practice. This study aimed at analyzing predictors of functional outcome of ET in patients with BAO to improve patient selection for ET.

Consecutive patients with BAO who received ET over a 2-year time period were prospectively studied. Baseline characteristics, procedural and outcome data were evaluated. Outcome was assessed by the modified Rankin Scale (mRS) 90 days after stroke. Multivariate regression analyses were performed to identify predictors of outcome across the range of the mRS, of poor outcome (mRS 5-6) and independent outcome (mRS 0-2).

A total of 39 patients with BAO (median age: 75 years, 67% male) were included. Median baseline National Institutes of Health Stroke Scale (NIHSS) score was 24. Intravenous thrombolysis therapy (IVT) was administered in 56%. Successful recanalization assessed by a modified thrombolysis in cerebral infarction (TICI) score ≥2b was achieved in 82%. Independent outcome was observed in 30% of patients with successful recanalization, but in no patient with failed recanalization. Poor outcome was observed in 47% and 86%, respectively. Successful recanalization was associated with lower scores on the mRS at 90 days (p = 0.035), and failed recanalization was associated with an odds ratio of 13.6 for poor outcome (p = 0.036).

Reperfusion is the major predictor of functional outcome in BAO in clinical practice. Failed recanalization resulted in a 13-fold increase of the risk of poor outcome. Successful recanalization is crucial to achieve a better functional outcome in BAO.