Integrated predictors of outcome in vertebrobasilar artery occlusion treated With endovascular therapy

Endovascular therapy (EVT) for vertebrobasilar artery occlusion (VBAO) has shown encouraging results in recent randomized trials, yet functional outcomes remain highly variable despite high rates of recanalization. This discrepancy suggests the need to better understand the factors that determine whether reperfusion translates into meaningful neurological recovery. In this review, we summarize current evidence on clinical, imaging, and procedural predictors associated with prognosis following EVT for VBAO. Clinical severity and level of consciousness provide initial insight but are insufficient for reliable decision-making. Imaging-particularly the assessment of brainstem involvement, collateral circulation, and perfusion status-emerges as the most decisive predictor of outcome and an important determinant of futile vs. effective recanalization. Procedural factors, including first-pass effect, treatment timing, device strategy, and anesthesia selection, further influence the likelihood of achieving functional improvement. By integrating these multidimensional predictors, this review proposes a comprehensive framework to support more precise patient selection and guide future research aimed at improving outcomes in posterior circulation stroke.