Abstract TP313: Predictors of Adjunctive Stenting/Angioplasty After Thrombectomy for Basilar Artery Occlusion

Introduction: Posterior circulation strokes account for nearly 20% of ischemic strokes and are a major cause of long-term disability and death. Randomized trials have shown benefit of endovascular therapy (EVT) in these patients with NIHSS ≥10 within 24 hours. Despite high reperfusion rates, adjunctive stenting or angioplasty is often needed. This study aimed to identify predictors of good functional outcome and the need for adjunctive stenting or angioplasty after basilar artery occlusion (BAO). Methods: We retrospectively analyzed consecutive patients undergoing EVT for BAO at a Stroke Belt tertiary stroke center between January 2021 and June 2025. We collected demographics, vascular risk factors, NIHSS, stroke mechanism, and procedural details. Primary outcomes were favorable functional outcome (90 day mRS 0–3) and need for adjunctive intervention such as stenting and angioplasty. Secondary outcomes included post-procedure ICH and good disposition (home or inpatient rehabilitation). Multivariate logistic regression identified independent predictors of favorable functional outcome and adjunctive intervention. Results: We identified 64 patients undergoing BAO EVT (median 62.5 years, 34% female, median NIHSS 17). Younger age (median 53 vs. 64 years), lower admission NIHSS (median 12 vs. 18), and IV thrombolytic use (38.5 vs. 19.6%) were associated with a favorable outcome. No patients with incomplete reperfusion (TICI ≤2a) achieved mRS 0–3. Adjunctive interventions were used in 20% of EVT cases (9 stenting, 10 angioplasty, 6 with both). These patients were numerically younger and male (non-significant) and had more EVT passes. These procedures were most often utilized in proximal and middle basilar occlusions but were not associated with stroke mechanism, disposition, or functional outcome. Despite numerically higher rates of thrombolytic use, we observed similar rates of post procedure radiographic and symptomatic ICH. Discussion: While baseline severity and reperfusion success remain critical determinants of functional outcome for BAO, predictors of need for adjunctive stenting or angioplasty are less clearly defined. Our sample had lower rates of intracranial atherosclerosis, higher rates of adjunctive therapy, and overall worse outcomes than some published trials, highlighting the heterogeneity of real-world populations compared to clinical trial cohorts. Further study is needed to clarify the role of angioplasty and stenting following EVT in BAO.