One-Year Outcome and Disability in Patients ≥80 Years following Endovascular Treatment of Basilar Artery Occlusion

Among stroke syndromes, acute basilar artery occlusion (BAO) is associated with the worst outcomes and highest mortality. Existing studies suggest that endovascular thrombectomy (EVT) significantly improves functional outcomes at 90 days. While EVT is generally safe across ages and severities, additional data are needed to identify patients at risk of unfavourable long-term outcomes.

This prospective, registry-based, single-centre, cohort study spanning 18 years evaluated functional independence in BAO patients at 3 months (primary outcome) and 1 year (secondary outcome) post-intervention (n=149; median age 70 years). Patients from the recent 8-year period were individually analysed at discharge and 3 months (n=126; median age 77 years). Safety outcomes included reperfusion status, major complications, and mortality, with one-year outcomes assessed through standardised telephone interviews.

Successful reperfusion was achieved in up to 91.9%. Favourable outcomes occurred in 34.2% of patients at three and 36.9% at 12 months. Overall mortality was 34.2% at 3 months and increased to 45.6% at 12 months, regardless of reperfusion success. Mortality was significantly higher in those aged ≥80, at 41.9% (3 m) and 62.8% (12 m), with only 14% achieving favourable outcomes at 12 months. An initial National Institutes of Health Stroke Scale (NIHSS) score ≥20 further predicted poorer outcomes, with no patient ≥80 with a score ≥20 (n=25) having favourable outcomes at one year, and 68% died.

While EVT increases the chances of independent living one-year post-event in patients with favourable predictive factors, elderly individuals with significant initial deficits are at a high risk of severe disabilities and mortality. Prognoses based solely on the first three months may lead to overestimations of benefit in this demographic.