Endovascular Thrombectomy for Acute Vertebrobasilar Artery Occlusion with Mild Deficits: A Multicenter Registry Study

Background Endovascular thrombectomy (EVT) is an effective method for vertebrobasilar artery occlusion (VBAO) in patients with moderate to severe deficits but has unclear benefits in patients with low National Institutes of Health Stroke Scale (NIHSS) scores at hospital admission. Purpose To compare the clinical outcomes of best medical management (BMM) alone versus BMM and early EVT (door-to-puncture time [DPT] ≤ 120 minutes) versus BMM and late EVT (DPT > 120 minutes) in patients with VBAO who have NIHSS scores of 10 or less at admission. Materials and Methods This retrospective study evaluated patients with VBAO and admission NIHSS score of 10 or less who were seen at 65 stroke centers in China from December 2015 to June 2022. The primary outcome was whether the patient achieved a favorable functional outcome (a modified Rankin scale [mRS] score of 0-3 at 90 days). Adjusted multivariable logistic regression analyses were used to assess the association between treatment (BMM alone vs early EVT and BMM vs late EVT and BMM) and outcomes. Results Among 1365 patients (mean age ± SD, 65 years ± 12; 951 male) with VBAO and an NIHSS score of 10 or less at admission, 489 patients (35.8%) received EVT. Of these, 382 (78.1%) received early EVT, and 107 (21.9%) received late EVT. After adjustment for confounders, compared with BMM alone, early EVT plus BMM was associated with increased rates of favorable functional outcome (odds ratio [OR], 1.41 [95% CI: 1.05, 1.87]; <i>P</i> = .02), whereas late EVT plus BMM did not outperform BMM alone (OR, 0.83 [95% CI: 0.54, 1.28]; <i>P</i> = .39). Conclusion In patients with VBAO admitted with an NIHSS score of 10 or less, early EVT (DPT ≤ 120 minutes) combined with BMM outperformed BMM alone, whereas late EVT (DPT > 120 minutes) combined with BMM did not outperform BMM alone. © RSNA, 2025 <i>Supplemental material is available for this article.</i>