Contact Aspiration Versus Combined Thrombectomy in Basilar Artery Occlusion: Clinical Severity and First-pass...

Acute basilar artery occlusion (BAO) carries high rates of death and disability despite endovascular therapy, and the optimal technique remains unclear. We compared contact aspiration (CA) alone with combined CA plus stent retriever (CA + SR) and identified factors associated with first-pass reperfusion and 3‑month outcome.

In the prospective multicenter SARA-3 registry, the primary outcomes compared between CA and CA + SR were first-pass recanalization (modified Treatment in Cerebral Infarction [mTICI] 2b-3) and 3‑month functional independence. Secondary outcomes were final recanalization, procedural time, safety, 24‑h NIHSS, and mortality. Factors associated with unfavorable outcome (modified Rankin Scale [mRS] 3-6) were assessed by Firth penalized logistic regression, with first-line technique forced in as a sensitivity analysis.

Among 68 patients (median admission National Institutes of Health Stroke Scale [NIHSS] 11), 50 (73.5%) received CA and 18 (26.5%) CA + SR. The two techniques showed no statistically significant differences in reperfusion, safety, or 3‑month unfavorable outcome (48% vs. 53%; underpowered), but CA was faster (21 vs. 38 min; P = 0.007). Admission NIHSS (odds ratio [OR] 1.08 per point; P = 0.004) and first-pass mTICI 2b-3 (OR 0.06; P < 0.001) were independently associated with outcome; their combination discriminated well (area under the curve 0.83). Forcing technique into the model did not change these associations (CA + SR adjusted OR 1.19; P = 0.81). No baseline characteristic was independently associated with first-pass reperfusion.

CA and CA + SR showed no statistically significant difference in 3‑month outcomes, but CA was faster. First-line technique was not associated with functional outcome; instead, outcome reflected baseline stroke severity and first-pass reperfusion, which defined prognostic groups that may aid risk stratification if externally validated.