First-pass effect after acute basilar artery occlusion: a comparison of mechanical thrombectomy techniques
BACKGROUND: Mechanical thrombectomy (MT) is effective for acute basilar artery occlusion (BAO), but the optimal technique for rapid recanalization and improved outcomes remains unclear. OBJECTIVE: We compared stent retriever (SR), contact aspiration (CA), and combined SR plus CA techniques as first-line approaches during MT for BAO. METHODS: We emulated a hypothetical trial comparing CA, SR, and combined technique as first-line in BAO patients. The primary outcome was first-pass effect (FPE), defined as modified Thrombolysis in Cerebral Infarction (mTICI) 3 with one pass of MT. Secondary outcomes included modified FPE (mFPE), functional outcome at 90 days, successful recanalization, and safety outcomes. We used inverse probability weighting (IPW) adjusted for prespecified covariates. RESULTS: The study included 960 BAO patients: 570 treated with CA, 268 with SR, and 122 with combined technique as the first approach. After applying IPW, SR was associated with lower odds of FPE (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.90) and of mFPE (aOR 0.48, 95% CI 0.33 to 0.70) compared with CA. No differences were found between the combined technique and either SR or CA. A 90-day modified Rankin Scale (mRS) 0-3 after mFPE was less frequent with SR (aOR 0.57, 95% CI 0.38 to 0.85) and with combined technique (aOR 0.50, 95% CI 0.28 to 0.89) compared with CA. Additionally, combined technique showed lower odds of mRS 0-1 at 90 days compared with CA (aOR 0.56, 95% CI 0.33 to 0.94). CONCLUSIONS: In BAO patients, CA was more effective than SR for complete and successful recanalization after first pass and resulted in better outcomes after mFPE as compared with other techniques. Less traumatic approaches might be preferred as first-line in BAO.
Authors
- Ilaria Casetta (ORCID: https://orcid.org/0000-0003-4099-8875)
- Giancarlo Salsano (ORCID: https://orcid.org/0000-0003-0602-7952)
- Guido Andrea Lazzarotti (ORCID: https://orcid.org/0000-0002-7135-758X)
- Mirco Cosottini (ORCID: https://orcid.org/0000-0001-9400-6574)
- Andrea Zini (ORCID: https://orcid.org/0000-0003-1486-4507)
- Andrea Saletti (ORCID: https://orcid.org/0000-0001-6984-113X)
- Vittorio Semeraro (ORCID: https://orcid.org/0000-0002-7546-4251)
- Guido Bigliardi (ORCID: https://orcid.org/0000-0001-5312-7206)
- Arianna Rustici (ORCID: https://orcid.org/0000-0002-3753-6189)
- Maria Pia Prontera
- Luca Milonia (ORCID: https://orcid.org/0000-0002-5256-6159)
- Valentina Saia (ORCID: https://orcid.org/0000-0001-9855-8894)
- Francesco Cordici
- Manuela De Michele (ORCID: https://orcid.org/0000-0002-3928-4309)
- Manuel Cappellari (ORCID: https://orcid.org/0000-0002-3534-3201)
- Ettore Nicolini (ORCID: https://orcid.org/0000-0002-8481-6327)
- Arianna Camilli (ORCID: https://orcid.org/0009-0007-7968-6808)
- Enrico Fainardi (ORCID: https://orcid.org/0000-0003-0477-724X)
- Marina Diomedi (ORCID: https://orcid.org/0000-0001-7569-1414)
- Alessandro De Vito (ORCID: https://orcid.org/0000-0002-7572-819X)
- Mauro Bergui (ORCID: https://orcid.org/0000-0002-5336-695X)
- Antonio Ciacciarelli (ORCID: https://orcid.org/0000-0003-3282-4672)
- Elena Coco
- Antioco Sanna (ORCID: https://orcid.org/0009-0001-5670-4280)
- Salvatore Mangiafico (ORCID: https://orcid.org/0000-0002-9102-0220)
- Fabrizio Sallustio (ORCID: https://orcid.org/0000-0002-8229-465X)
- Domenico Sergio Zimatore (ORCID: https://orcid.org/0000-0001-7185-890X)
- Stefano Vallone
- Rossana Tassi (ORCID: https://orcid.org/0000-0002-5906-8718)
- Michele Besana
- R. Menozzi (ORCID: https://orcid.org/0000-0002-3867-3302)
- Valerio Da Ros (ORCID: https://orcid.org/0000-0001-7167-7594)
- Sandra Bracco (ORCID: https://orcid.org/0000-0002-4721-1425)
- Elena Barrile (ORCID: https://orcid.org/0009-0000-8726-572X)
- Giovanni Pracucci
- Tiziana Benzi Markushi
- Nicola Loizzo
- Francesca Gatti
- Danilo Toni
- Alessia Giossi
- Marco Petruzzellis
- Alessandro Pezzini (ORCID: https://orcid.org/0009-0006-6717-3522)
- Patrizia Nencini
Institutions
- University of Pisa (IT)
- University of Rome Tor Vergata (IT)
- University of Parma (IT)
- Policlinico Umberto I (IT)
- Istituto Neurologico Mediterraneo (IT)
- Azienda Unita' Sanitaria Locale Di Modena (IT)
- Azienda Ospedaliera Universitaria Integrata Verona (IT)
- Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT)
- Fondazione Istituto Neurologico Nazionale Casimiro Mondino (IT)
- Azienda Ospedaliero-Universitaria di Modena (IT)
- Ospedale “M. Bufalini” di Cesena (IT)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Istituto delle Scienze Neurologiche di Bologna (IT)
- Arcispedale Sant'Anna (IT)
- Azienda Ospedaliera Universitaria Senese (IT)
- Ospedale di Parma (IT)
- Ospedale Policlinico San Martino (IT)
- Ospedale SS. Annunziata (IT)
- Policlinico San Matteo Fondazione (IT)
- Dipartimento della Protezione Civile (IT)
- Ospedale Santa Corona (IT)
- Azienda Ospedaliera Universitaria Pisana (IT)
- Istituti Ospitalieri di Cremona (IT)
- University of Florence (IT)
- University of Turin (IT)
- Sapienza University of Rome (IT)
Publication Details
- Journal
- Journal of NeuroInterventional Surgery
- Published
- 2026-06-30
- DOI
- https://doi.org/10.1136/jnis-2026-025360
- Primary Topic
- Acute Ischemic Stroke Management
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Ministero della Salute