Abstract DP129: Effectiveness of Endovascular Treatment for Acute Mild Basilar Artery Occlusion Stroke: A Multicenter Real-World Study

Background and aims: 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 study aimed to explore the EVT efficacy in acute BAO with a low National Institutes of Health Stroke Scale (NIHSS). Methods: Patients with acute BAO and NIHSS<10, hospitalized at 5 stroke centers in China between January 2020 and December 2023, were included and divided into EVT and standard medical treatment (SMT) groups. The primary outcome was 90-day functional independence defined as a modified Rankin Scale (mRS) of 0-2. Secondary outcomes include proportions of 90-day mRS 0-1 and 0-3. Symptomatic intracerebral hemorrhage (sICH) within 48 hours and 90-day mortality were assessed as safety outcomes. Results: 315 BAO patients with NIHSS <10 were enrolled (229 72.7% male; median IQR age, 65 58-72 years; median IQR baseline NIHSS, 6 3-8 points), 161 (51.1%) of whom underwent EVT and 154 (48.9%) received SMT only. The EVT group had a higher rate of 90-day functional independence (68.9% vs. 44.8%, adjusted OR, 3.69 95% CI, 2.04-6.68; P <.001). There was no significant difference in 90-day mortality (4.3% vs. 4.5%, adjusted OR, 1.22 95% CI, 0.37-4.03; P =.80), however, EVT was associated with a higher risk of sICH (8.2% vs. 3.9%, adjusted OR, 3.86 95% CI, 1.18-12.61; P =.03). Conclusions: In this cohort of patients with acute mild BAO, EVT was associated with an improved 90-day functional outcome compared with SMT alone, although increasing the risk of sICH.