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

Background: Endovascular thrombectomy (EVT) benefits basilar artery occlusion (BAO) patients with moderate-to-severe deficits, but its role in patients with mild neurological deficits (NIHSS ≤10) remains controversial. This study aimed to compare clinical and safety outcomes of EVT plus medical management (MM) versus MM alone in acute BAO patients with mild deficits.

Methods: Ninety-eight patients from the BASILAR registry met the criteria and were included in this analysis (EVT: n = 70; MM: n = 28). Inverse probability weighting (IPW) adjusted for baseline imbalances. A systematic review and meta-analysis of seven studies was conducted to synthesize existing evidence. Interventions included EVT plus MM versus MM alone. The primary outcome was 90-day functional independence (modified Rankin Scale [mRS] 0-2); secondary outcomes included excellent (mRS 0-1) and favorable (mRS 0-3) outcomes, mortality, and symptomatic intracranial hemorrhage (sICH).

Results: In the BASILAR cohort, EVT was associated with higher likelihood of functional independence (IPW-adjusted odds ratio [aOR] 8.46, 95% CI 2.29-31.17; p < 0.001) versus MM, with no increased risk of sICH (1.3% vs. 0%) and death (aOR 0.35, 95% CI 0.07-1.63, p = 0.18). Meta-analysis confirmed higher association of EVT with higher odds of functional independence (pooled aOR 1.78, 95% CI 1.00-3.18; p = 0.05) and excellent outcomes (aOR 3.98, 95% CI 1.32-11.95; p = 0.01), without elevated risk of sICH and death.

Conclusion: In acute BAO patients with mild neurological deficits, EVT was associated with improved functional independence without increased risks of mortality or sICH. These findings advocate for reconsidering the role of EVT role in this population, pending validation through randomized trials.