Presentation, treatment and outcomes of acute basilar artery occlusion: A retrospective analysis

We aim to assess the clinical presentation, treatment, and outcomes in patients with acute basilar artery occlusion (BAO) after receiving medical management (MM) (including IV thrombolysis, antiplatelet, anticoagulation) and endovascular therapy (EVT) (including intra-arterial thrombolysis, stent placement, mechanical thrombectomy).

This is a retrospective cohort study including all adult patients treated at three Mayo Clinic stroke centers with acute BAO from 2008 to 2021. Chart review was conducted to extract details of presentation, treatment, and outcome. Comparisons of treatment outcomes between patients treated with MM and EVT were analyzed and include changes of modified Rankin Scale (mRS) and NIHSS score change from admission to discharge.

A total of 182 patients were included in our final analysis: 95 in the MM group and 87 in the EVT group. There was a statistically significant difference in favorable functional outcome at discharge (mRS 0-3) favoring the MM group compared to EVT group (56.0 % vs 34.9 %; OR 0.42, p = 0.005) and the difference remained significant in multivariate analysis (OR 0.38, p = 0.048). There were significantly increased odds of having NIHSS improvement of >5 points (OR 3.94 p < 0.001), and 10 points (OR 3.92 p < 0.001) in patients treated with EVT compared to MM.

Our data demonstrates that although in general patients who received EVT had lower odds of having favorable outcomes at discharge, they were also more likely to have NIHSS score improvement of >5 and 10 points from presentation to discharge compared to MM, suggesting EVT could be beneficial in some patients.