The landscape of acute ischemic stroke treatment changed dramatically with endovascular thrombectomy (EVT).
However, few patients with basilar artery occlusions were included in major EVT trials.
Basilar artery occlusion accounts for 10% of large vessel occlusions and can result in devastating neurological deficits.
The recently published BASICS trial evaluated the efficacy of EVT within 6 hours of symptom onset in 300 patients with basilar artery occlusion strokes.
44.2% of the EVT group had a good outcome compared to 37.7% of the medical treatment group (p=0.19).
Good outcome was defined as modified Rankin scale of 0 (no symptoms) to 3 (moderate disability but able to walk without assistance) at 90 days.
Symptomatic intracranial hemorrhage was higher in the EVT group (4.5% vs. 0.7%, p=0.06).
History of AFib was more common in the EVT group (28.6% vs. 15.1%).
It is important to note that this study did not use advanced neuroimaging for patient selection unlike in landmark EVT trials of anterior circulation large vessel occlusion strokes.
Bottom Line: There is no significant difference between endovascular thrombectomy and medical management for basilar artery occlusion strokes within 6 hours of symptom onset.
References
Langezaal LCM, van der Hoeven EJRJ, Mont’Alverne FJA, et al. Endovascular therapy for stroke due to basilar-artery occlusion. N Engl J Med. 2021;384(20):1910-20.
