Abstract 285: First‐Line Mechanical Thrombectomy Techniques and Clinical Outcomes In Basilar Artery Occlusions With Favorable Collaterals

Introduction Mechanical thrombectomy (MT) has been demonstrated to be associated with improved clinical outcomes in patients with acute basilar artery occlusions (BAO) compared to medical management. The basilar artery on computed tomography angiography (BATMAN) score provides enhanced collateral prognostic accuracy in BAO patients. This study is aimed to determine if there is a correlation between first line mechanical thrombectomy techniques and subsequent clinical outcomes factoring their baseline BATMAN scoring. Methods/Materials We included patients who presented to our comprehensive stroke center between 2014 and 2023 and underwent MT for BAO. This cohort was subsequently divided into two groups based on the BATMAN score (≥7 vs. <7), and further subdivided within each group according to first‐line technique (Contact aspiration vs combined). We compared age, sex, posterior circulation ASPECT score (pc‐ASPECT), admission NIHSS, and mTICI (2b/2c‐3) between groups. Outcomes, including modified Rankin Scale (mRS) at 90 days, symptomatic intracranial hemorrhage, and mortality, were assessed for both groups. Results Of the 193 patients with BAO who received mechanical thrombectomy, 67 (34.7%) of them were found to have a favorable BATMAN score (>=7). We found that lower arrival NIHSS and higher pc‐ASPECT scores were significantly associated with favorable BATMAN score (p‐values 0.004 and 0.016, respectively). Aspiration only as the first line technique was associated with increased rates of TICI2B‐3 reperfusions compared to combined techniques (aOR 4.86, 95% CI 1.1‐26.3; P‐value 0.044) among patients with BATMAN (>=7). Despite absolute numerical differences in outcomes (mRS 0‐2; 31.7% vs 26.5%, Mortality; 41.3% vs 53.9) suggesting potential disparities between the two groups and their subgroups, these differences did not reach statistical significance. Conclusions Aspiration as the first line technique was associated with increased rates of TICI 2b‐3 in patients with BATMAN score >=7. Further studies with larger populations might establish correlation with improved functional outcomes.