ABSTRACT NUMBER: ESOC2026A2502 INTRACRANIAL ATHEROSCLEROSIS DOES NOT MODIFY THE BENEFIT OF ENDOVASCULAR THERAPY IN BASILAR ARTERY OCCLUSION: AN INDIVIDUAL PATIENT DATA META-ANALYSIS (VERITAS)

Abstract Background and aims To determine whether the efficacy and safety of endovascular therapy (EVT) for basilar artery occlusion are modified by the presence of intracranial atherosclerotic disease (ICAD). Methods We performed an individual patient data meta-analysis pooling randomized controlled trial data from BASICS, BEST, ATTENTION, and BAOCHE. Patients were classified by ICAD status. The primary outcome was a favorable functional outcome (mRS 0–3) at 90 days. Secondary outcomes included functional independence (mRS 0–2), ordinal mRS shift, and 90-day mortality. Mixed-effects logistic regression models adjusted for baseline covariates were used, with trial included as a random effect. Effect modification by ICAD status was assessed using interaction testing. Results Among 832 patients with known ICAD status, 491 had no ICAD, and 341 had ICAD. EVT was associated with higher odds of favorable outcome (mRS 0–3) in both non-ICAD (adjusted odds ratio [aOR] 2.52, 95% CI 1.66–3.83) and ICAD patients (aOR 2.50, 95% CI 1.47–4.25), with no evidence of effect modification (p-interaction = 0.98). Consistent benefit was observed for functional independence (non-ICAD: aOR 2.75; ICAD: aOR 3.22; p-interaction = 0.68) and ordinal mRS shift (non-ICAD: aOR 2.15; ICAD: aOR 2.24;p-interaction = 0.89). EVT was also associated with reduced 90-day mortality in both groups (non-ICAD: aOR 0.53; ICAD: aOR 0.64; p-interaction = 0.56). Symptomatic intracranial hemorrhage was more frequent with EVT in both non-ICAD (3.9%vs.0.9%) and ICAD patients (6.0%vs.0.0%). Conclusions Endovascular therapy confers substantial and consistent benefit in basilar artery occlusion regardless of ICAD status. The presence of ICAD should not preclude patients from EVT. Conflict of interest No relevant disclosures to this work.