Endovascular therapy for mild-to-moderate stroke due to basilar artery occlusion: A systematic review and meta-analysis

Background Endovascular therapy (EVT) is an established treatment for basilar artery occlusion (BAO) with severe deficits, but its benefit in patients with mild-to-moderate symptoms (National Institutes of Health Stroke Scale NIHSS <10) remains unclear due to limited randomized controlled trial (RCT) evidence. We performed a systematic review and meta-analysis to evaluate EVT efficacy and safety in this subgroup. Methods We searched PubMed, Embase, and the Cochrane Library for RCTs and observational studies published between January 1, 2014, and July 1, 2026, comparing EVT plus best medical treatment (BMT) versus BMT in BAO with NIHSS <10. The primary outcome was 90-day good functional status (modified Rankin Scale mRS 0–2). Secondary outcomes were favorable (mRS 0–3) and excellent (mRS 0–1) functional status. Safety outcomes included 90-day mortality, any intracerebral hemorrhage (ICH) and symptomatic ICH. Results Fifteen studies comprising 3981 patients (1812 EVT; 2169 BMT) were included. No significant differences were observed in good (OR = 1.51; 95% CI 0.89–2.54; p = 0.12) or favorable functional status (OR = 0.99; 95% CI 0.75–1.30; p = 0.92), while EVT increased the odds of excellent status (OR = 2.01; 95% CI 1.33–3.05; p < 0.001). Mortality (OR = 0.94; 95% CI 0.55–1.59), any ICH (OR = 1.23; 95% CI 0.69–2.19) and symptomatic ICH (OR = 0.98; 95% CI 0.61–1.57) were comparable. Conclusion Although no difference emerged for the primary outcome, EVT increased the likelihood of excellent recovery without compromising safety. These findings highlight the need for RCTs targeting this population.