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Publications

Journal Article Ahead of print

PubMed: 41698454 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108590

OUTCOMES PREDICTORS IN PATIENTS WITH BASILAR ARTERY OCCLUSION AND MILD DEFICITS, TREATED WITH MECHANICAL THROMBECTOMY: A MULTICENTER RETROSPECTIVE OBSERVATIONAL STUDY.

J Stroke Cerebrovasc Dis

Authors: Simone Bellavia, Andrea M Alexandre, Luca Scarcia, Valerio Brunetti, Alessandro Pedicelli, Giovanni Frisullo, Joseph D Gabrieli, Francesco Causin, Valerio Da Ros, Federico Sabuzi, Daniele G Romano, Giulia Frauenfelder, Antonio A Caragliano, Orazio Buonomo, Vittorio Semeraro, Maria P Ganimede, Giancarlo Salsano, Nicola Mavilio, Nicolas Chausson, Ghil Schwarz, Angelo Cascio Rizzo, Mariangela Piano, Stefano Caproni, Carlo Colosimo, Serena Abruzzese, Emilio Lozupone, Paolo Calabresi, Aldobrando Broccolini

Affiliations

  • Catholic University School of Medicine, Rome Italy; ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Interventional Neuroradiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Neuroradiology Unit, Henri Mondor Hospital, Creteil, France.
  • Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Neuroradiology Unit, Policlinico Universitario di Padova, Padua, Italy.
  • Department of Biomedicine and Prevention, University Hospital of Rome "Tor Vergata", Rome, Italy.
  • Neuroradiology Unit, AOU S Giovanni di Dio e Ruggi di Aragona, Salerno, Italy.
  • Neuroradiology Unit, AOU Policlinico G. Martino, Messina, Italy.
  • Interventional Radiology Unit, "SS Annunziata" Hospital, Taranto, Italy.
  • Neuroradiology Unit, "SS Annunziata" Hospital, Taranto, Italy.
  • Neuroradiology Unit, San Martino Hospital, Genua, Italy.
  • Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France.
  • ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Ospedale Universitario "S. Maria", Terni, Italy.
  • Catholic University School of Medicine, Rome Italy.
  • Neuroradiology Unit, Vito Fazzi Hospital, Lecce, Italy.
  • Catholic University School of Medicine, Rome Italy; Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Catholic University School of Medicine, Rome Italy; Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Abstract

BACKGROUND

Basilar artery occlusion patients presenting with NIHSS<10 were an underrepresented population in recent clinical trial assessing the benefit of mechanical thrombectomy (MT) over best medical management (BMM). Despite European guidelines suggesting BMM as first treatment approach in such patients, current evidence is conflicting and MT could still be beneficial in carefully selected patients. In this study we aimed to investigate pre-procedural and procedural variables influencing the neurological outcome in MT treated patients presenting with BAO and mild symptoms.

METHODS

We conducted a retrospective observational study collecting data from 10 large European stroke centers gathering consecutive patients presenting with BAO and NIHSS<10, between January 2017 and December 2024. We performed an outcome analysis in MT-treated patients with a pre-event mRS < 3, assessing the achievement of a 3-month modified Rankin Scale (mRS) score of 0-2 (vs 3-6) and 0-3 (vs 4-6). A sensitivity analysis restricted to patients with admission NIHSS <6 was conducted for the mRS 0-2 outcome.

RESULTS

Among 148 BAO patients with onset NIHSS<10, 128 (86.5%) were treated with immediate-MT plus BMM, while 20 (13.5%) with BMM-alone of which 8/11 (72.7%) were switched to a rescue-MT after neurological deterioration. Among 133 MT treated patients, 93/133 (69.9%) reached a mRS 0-2 and 101/133 (75.9%) a mRS 0-3. Overall, in MT treated patients, involving both immediate-MT and rescue-MT, an occlusion localized beyond the superior cerebellar artery was an independent predictor of mRS 0-2 [O.R. 7.11; 95% C.I. 2.50-20.24; p<0.001] and mRS 0-3 [O.R.12.07; 95% C.I. 3.27-44.55; p<0.001] at three months. A distal occlusion acted as an independent predictor of mRS 0-2 also in the subgroup with admission NIHSS<6 [O.R. 5.13; 95% C.I. 1.19-22.11; p= 0.028].

CONCLUSION

In BAO patients with mild symptoms undergoing MT, a distal occlusion located beyond the superior cerebellar artery is a strong independent predictor of favorable functional outcome at three months. These findings highlight the importance of considering occlusion site when selecting patients with mild BAO for MT.

MeSH

Arteries, Signs And Symptoms, Cerebrovascular Disorders, Thrombectomy, Basilar Artery