UMEM Educational Pearls

Category: Neurology

Title: Thrombectomy for Basilar Artery Occlusion?

Keywords: stroke, large vessel occlusion, basilar artery, posterior circulation, thrombectomy (PubMed Search)

Posted: 6/9/2021 by WanTsu Wendy Chang, MD
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  • 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. 


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. 
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