Endovascular thrombectomy versus medical management for basilar artery occlusion stroke with mild neurological deficit - results from the BASILAR registry.

In 30 seconds

This comparative analysis examined endovascular thrombectomy (EVT) plus medical management versus medical management alone in acute basilar artery occlusion with mild neurological deficits (NIHSS ≤10). It included 98 patients from the BASILAR registry, adjusted for baseline differences using inverse probability weighting, and combined results with a systematic review and meta-analysis of seven studies. In the registry cohort, EVT was associated with greater odds of 90-day functional independence (adjusted odds ratio 8.46, 95% CI 2.29-31.17; p < 0.001), without a detected increase in symptomatic intracranial hemorrhage or death.

Key findings

• In the BASILAR cohort, EVT was associated with higher odds of functional independence: adjusted odds ratio 8.46, 95% CI 2.29-31.17; p < 0.001.
• Symptomatic intracranial hemorrhage occurred in 1.3% vs. 0%; death was not significantly associated with EVT (adjusted odds ratio 0.35, 95% CI 0.07-1.63, p = 0.18).
• Across seven studies, EVT was associated with functional independence (pooled adjusted odds ratio 1.78, 95% CI 1.00-3.18; p = 0.05) and excellent outcomes (adjusted odds ratio 3.98, 95% CI 1.32-11.95; p = 0.01).

Why it matters

Basilar artery occlusion can have serious consequences, yet the role of thrombectomy in patients presenting with mild deficits is uncertain. These findings add comparative and pooled evidence suggesting a possible functional benefit without an observed increase in symptomatic intracranial hemorrhage or mortality. The results may inform clinical discussion, while the non-randomised evidence and call for randomized validation warrant caution.

What to keep in mind

The registry comparison was observational, despite adjustment for baseline imbalances; the authors state that randomized trials are needed to validate the findings.