Therapeutic Efficacy of Endovascular Thrombectomy in Acute Basilar Artery Occlusion with Mild Symptoms

Background The clinical benefit of endovascular thrombectomy (EVT) for acute basilar artery occlusion (BAO) in patients with mild symptoms remains controversial. Purpose To evaluate the efficacy and safety of EVT versus intravenous thrombolysis (IVT) in patients with BAO with National Institutes of Health Stroke Scale (NIHSS) scores of 0-9 or 0-5. Materials and Methods In a multicenter retrospective study between January 2018 and January 2024, outcomes in patients with BAO with NIHSS scores of 0-9 or 0-5 who underwent EVT or IVT were compared using inverse probability weighting (IPW) methods. In a meta-analysis, studies (published until April 1, 2025) comparing EVT and medical management (ie, control treatment) in BAO were identified. Results The retrospective study included 200 patients (median age, 69 years [IQR, 60-76 years]; 137 men), and the meta-analysis included six studies encompassing 3014 patients. Among patients with NIHSS scores of 0-9, after IPW, EVT was associated with a higher likelihood of excellent functional outcome (modified Rankin Scale [mRS] score of 0-1) compared with IVT (adjusted odds ratio [OR], 2.02 [95% CI: 1.05, 3.86]; <i>P</i> = .04). In contrast, among patients with NIHSS scores of 0-5 (<i>n</i> = 52), EVT was associated with a lower likelihood of independent ambulation (mRS score of 0-3) than IVT (adjusted OR, 0.19 [95% CI: 0.05, 0.80]; <i>P</i> = .02). Meta-analysis indicated that in patients with NIHSS scores of 0-9, EVT was associated with a higher likelihood of excellent functional outcome compared with control treatment (adjusted OR, 2.15 [95% CI: 1.60, 2.91]; <i>P</i> < .001). However, among patients with NIHSS scores of 0-5, EVT was associated with a reduced likelihood of independent ambulation compared with control treatment (adjusted OR, 0.23 [95% CI: 0.09, 0.59]; <i>P</i> = .002). Conclusion Compared with IVT, EVT was associated with a higher likelihood of excellent functional outcome in patients with BAO with NIHSS scores of 0-9 but a lower likelihood of independent ambulation in patients with NIHSS scores of 0-5. © RSNA, 2025 <i>Supplemental material is available for this article.</i> See also the editorial by Kallmes and Rabinstein in this issue.