ABSTRACT NUMBER: ESOC2026LB12 LB12 - ENDOVASCULAR THROMBECTOMY WITH OR WITHOUT INTRAVENOUS ALTEPLASE IN ACUTE STROKE DUE TO BASILAR ARTERY OCCLUSION

Abstract Background and aims Endovascular treatment is safe and effective for acute ischemic stroke due to basilar artery occlusion (AIS-BAO); however, the efficacy of intravenous thrombolysis plus endovascular treatment remains unclear. This trial aims to investigate the efficacy and safety of endovascular treatment with or without intravenous alteplase for AIS-BAO patients treated within 4.5 hours of stroke onset. Methods BEST-BAO (NCT05631847) is a multicenter, prospective, randomized, open-label controlled clinical trial conducted at multiple stroke centers across China involving patients with BAO. Patients were randomly assigned in a 1:1 ratio to EVT alone (EVT alone group) or EVT preceded by intravenous alteplase at a dose of 0.9 mg/kg (alteplase plus EVT group). The primary outcome was functional independence, defined as a score of 0 to 2 on the modified Rankin Scale (mRS) at 90±14 days after stroke onset. Results In the modified intention-to-treat population of 345 patients (173 EVT alone, 172 alteplase plus EVT), 90-day functional independence occurred in 41.6% versus 41.3%, with an adjusted risk difference of 0.04 (95% CI, -0.05 to 0.14), showinging noninferiority of EVT alone. Mortality was 37.14% with EVT alone and 35.88% with intravenous alteplase plus EVT. Symptomatic intracerebral hemorrhage was similar between groups. Conclusions Among patients with acute ischemic stroke due to basilar artery occlusion presenting within 4.5 hours of symptom onset, EVT alone was noninferior but not superior to intravenous alteplase plus EVT in terms of 90-day functional outcomes. Conflict of interest