Background: The impact of endovascular thrombectomy in acute mild stroke due to basilar artery occlusion (BAO) remains uncertain, since these patients were usually excluded from previous clinical trials. This meta-analysis aimed to assess the efficacy and safety of endovascular thrombectomy in patients with acute mild BAO stroke. Methods: A comprehensive search was conducted across PubMed, Embase, and Web of Science databases from inception to August 5, 2025. Cohorts or clinical trials evaluating the effect of endovascular thrombectomy for acute mild BAO stroke, defined by a score on National Institutes of Health Stroke Scale (NIHSS) of ≤10, were included The efficacy outcomes include was the proportion of patients achieving an excellent functional outcome (defined as modified Rankin Scale mRS 0-1 at 90 days) and the proportion of those with 90-day functional independence (mRS 0-2). Safety measures included symptomatic intracranial hemorrhage (sICH) and mortality at 90 days. The risk ratio (RR) for each outcome was combined with meta-analysis in a random-effect model. Results: We identified 11 cohort studies, and no eligible clinical trial was found. A total of 3325 patients were included in the analysis. There were 524 of 1169 patients (44.8%) in the endovascular thrombectomy group and 508 of 1497 patients (33.9%) in the standard medical management group achieving mRS 0-1 at 90 days (risk ratio RR, 1.23 95% CI, 1.06-1.43; P =0.007), but the proportions of patients with mRS 0-2 at 90 days were similar between the groups (59.7% vs. 55.5%; RR, 1.05 0.99-1.11; P =0.13). There was no significant difference observed in sICH (4.5 % vs. 2.6%; RR, 1.55 95% CI, 0.62-3.87; P =0.35) or 90-day mortality (14.9% vs. 12.9%; RR, 1.08 95% CI, 0.91-1.30, P =0.37). Conclusion: Endovascular thrombectomy could increase the likelihood of obtaining an excellent functional outcome in acute BAO strokes with an NIHSS≤10 in a real-world setting without increasing risks of sICH and mortality. The benefit of endovascular thrombectomy for this population should be further confirmed by randomized trials.
Pan et al. (2026) studied this question.