Endovascular Therapy for Basilar Artery Occlusion

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Medicine

Background:

• Basilar artery occlusion (BAO) is a severe neurological condition with high mortality and disability rates.
• While endovascular therapy (EVT) shows promise in posterior circulation strokes, robust randomized controlled trial (RCT) evidence was historically lacking for BAO.
• Previous RCTs like BEST and BASICS yielded inconclusive results but informed future trial design.

Purpose of the Study:

• To review and contextualize the current evidence on the efficacy of endovascular therapy (EVT) for acute basilar artery occlusion (BAO).
• To examine the impact of recent positive randomized controlled trials on the treatment landscape for BAO.

Main Methods:

• Review of recent randomized controlled trials (ATTENTION and BAOCHE) investigating EVT for BAO.
• Analysis of trial methodologies, including recruitment strategies and patient selection.
• Comparison of EVT outcomes in BAO with those in anterior circulation large vessel occlusion ischemic stroke.

Main Results:

• The ATTENTION and BAOCHE trials demonstrated a significant benefit of EVT for patients with acute BAO within 24 hours of symptom onset.
• The treatment effect observed in these trials is comparable to that seen in anterior circulation large vessel occlusion.
• These positive trials succeeded where earlier trials failed due to optimized trial design, including rapid enrollment and minimized crossover.

Conclusions:

• Endovascular therapy is a beneficial treatment for acute basilar artery occlusion within a 24-hour window.
• The findings establish EVT as a standard of care for BAO, comparable to its use in anterior circulation strokes.
• Future research should build upon the success of recent trials in optimizing EVT delivery for posterior circulation stroke.