One-Year Outcome After Endovascular Thrombectomy for Basilar Artery Occlusion With Mild Deficits

The long-term benefits of endovascular thrombectomy (EVT) for basilar artery occlusion (BAO) in patients with low National Institutes of Health Stroke Scale scores upon admission remain unclear. This study aimed to compare the 1-year clinical follow-up outcomes of best medical management (BMM) alone versus BMM plus EVT.

Patients with BAO and admission National Institutes of Health Stroke Scale score of ≤10 at 65 stroke centers in China from December 2015 to June 2022 were retrospectively enrolled. The primary outcome was favorable functional outcome (a modified Rankin Scale score of 0-3 at 1 year). Early (door-to-puncture time ≤120 minutes) and late EVT (door-to-puncture time >120 minutes) classifications were defined as surrogates for comparing initial treatment with EVT versus late (potentially rescue) EVT after initially being treated with BMM only. Multivariable logistic regression and propensity score matching analyses were used to assess the association between treatment and outcomes.

Among 1232 patients who had 1-year follow-up data, 856 (69.5%) were men, and the mean (SD) age was 65 (12) years. After adjustment for confounders, there were no significant differences between EVT and BMM in favorable functional outcome (odds ratio, 0.96 [95% CI, 0.71-1.29]; P=0.778). The cumulative 1-year mortality rate was 16.4% in the EVT group versus 13.7% in the BMM group (odds ratio, 1.23 [95% CI, 0.86-1.77]; P=0.262). Predefined subgroup analyses revealed that late EVT was inferior to early EVT (odds ratio, 0.47 [95% CI, 0.28-0.79]; P=0.005), while no significant difference was observed between BMM and early EVT in 1-year outcomes (odds ratio, 0.87 [95% CI, 0.63-1.21]; P=0.421).

In this long-term follow-up study among patients with BAO admitted with a National Institutes of Health Stroke Scale score of ≤10, there were no significant differences in functional outcomes and mortality at 1 year between BMM plus EVT and BMM alone.