Effectiveness of Endovascular Treatment for Acute Mild Basilar Artery Occlusion Stroke: A Multicenter Real-World Study

BACKGROUND: Randomized trials have demonstrated the benefit of endovascular treatment (EVT) in moderate-to-severe acute basilar artery occlusion (BAO), but its benefit in acute mild BAO remains uncertain. This multicenter, retrospective cohort study aimed to explore the efficacy of EVT in acute BAO with a low National Institutes of Health Stroke Scale. METHODS: Patients with acute BAO and National Institutes of Health Stroke Scale <10, hospitalized at 5 stroke centers in China between January 2020 and December 2023, were included and divided into EVT and standard medical treatment groups. The primary outcome was 90-day functional independence, defined as a modified Rankin Scale score of 0 to 2. Secondary outcomes include proportions of 90-day modified Rankin Scale score of 0 to 1 and 0 to 3. Symptomatic intracerebral hemorrhage within 48 hours and 90-day mortality were assessed as safety outcomes. RESULTS: Three hundred fifteen patients with BAO with National Institutes of Health Stroke Scale <10 were enrolled (229 72.7% male; median interquartile range age, 65 58–72 years; median interquartile range baseline National Institutes of Health Stroke Scale score, 6 3–8 points), 161 (51.1%) of whom underwent EVT and 154 (48.9%) received standard medical treatment. The EVT group had a higher rate of 90-day functional independence (68.9% versus 44.8%; adjusted odds ratio, 3.69 95% CI, 2.04–6.68; P <0.001). There was no significant difference in 90-day mortality (4.3% versus 4.5%; adjusted odds ratio, 1.22 95% CI, 0.37–4.03; P =0.80). However, EVT was associated with a higher risk of symptomatic intracerebral hemorrhage (8.2% versus 3.9%; adjusted odds ratio, 3.86 95% CI, 1.18–12.61; P =0.03). CONCLUSIONS: In this cohort of patients with acute mild BAO, EVT was associated with an improved 90-day functional outcome compared with standard medical treatment alone, although the risk of symptomatic intracerebral hemorrhage was increased.