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BACKGROUND: Approximately half of patients who achieve successful reperfusion do not achieve functional independence. The present study sought to investigate the clinical outcomes and safety of intraarterial or intravenous tirofiban as adjunct therapy in patients with acute basilar artery occlusion who had achieved successful recanalization with endovascular treatment. METHODS AND RESULTS: In the national, prospective BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study) registry, 458 patients who met inclusion criteria were divided into 3 groups based on tirofiban administration (no tirofiban, n=262; intravenous tirofiban, n=101; intraarterial+intravenous tirofiban, n=95). Their clinical outcomes were compared with 90-day modified Rankin Scale scores. Adjusted odds ratios (aORs) and 95% CIs were obtained by logistic regression models and propensity score matching. Safety outcomes included any intracranial hemorrhage (ICH), symptomatic ICH, and mortality. Among 458 included patients, 184 (40.2%) achieved a favorable outcome (modified Rankin Scale score 0-3). There were no differences between the intravenous tirofiban group and the no tirofiban group in terms of safety and clinical outcomes (all P>0.05). Compared with the no tirofiban group, the intraarterial+intravenous tirofiban group had higher odds of 90-day modified Rankin Scale score 0 to 3 (aOR, 2.44 [95% CI, 1.30-4.64], P=0.006) and lower 3-month mortality (aOR, 0.38 [95% CI, 0.19-0.71], P=0.002) without an increase in any ICH (aOR, 0.34 [95% CI, 0.09-1.01], P=0.07) or symptomatic ICH (aOR, 0.23 [95% CI, 0.03-0.90], P=0.05). Similar results of intraarterial+intravenous tirofiban on improving clinical outcomes were detected in novel cohorts constructed by propensity score matching. CONCLUSIONS: Intraarterial+intravenous rather than intravenous tirofiban improved clinical outcomes without increasing the frequency of symptomatic ICH among patients with basilar artery occlusion after successful endovascular treatment. Further studies are needed to delineate the roles of intraarterial+intravenous tirofiban in patients with basilar artery occlusion receiving endovascular treatment.

Background and Purpose: Two early basilar artery occlusion (BAO) randomized controlled trials (RCTs) did not establish the superiority of endovascular thrombectomy (EVT) over medical management. Yet many providers continued to recommend EVT. The goal of the present article is to compare physicians' diagnostic and management strategies of BAO among middle-income and high-income countries (MICs and HICs, respectively). Methods: We conducted an international survey from January to March 2022 regarding management strategies in acute BAO, to examine clinical and imaging parameters influencing clinician management of patients with BAO. We compared responses between physicians from HIC and MIC. Results: Among the 1245 respondents from 73 countries, 799 (64.2%) were from HIC, with the remaining 393 (31.6%) from MIC. Most respondents perceived that EVT was superior to medical management for acute BAO, but more so in respondents from HIC (98.0% vs. 94.2%, p < 0.01). MIC respondents were more likely to believe further RCTs were warranted (91.6% vs. 74.0%, p < 0.01) and were more likely to find it acceptable to enroll any patient who met a trial's criteria in the standard medical treatment arm (58.8% vs. 38.5%, p < 0.01). Conclusions: In an area where clinical equipoise was called into question despite the lack of RCT evidence, we found that respondents from MIC were more likely to express willingness to enroll patients with BAO in an RCT than their HIC counterparts. [ABSTRACT FROM AUTHOR]

Background and Purpose: This study aimed to investigate the effect of collateral circulation on the outcomes of thrombectomy versus medical management alone in basilar artery occlusion (BAO) patients with varying stroke severities. Methods: Data from the ATTENTION cohort were used to perform a post‐hoc analysis comparing the outcomes of thrombectomy with medical management in BAO patients with varying degrees of collateral circulation and stroke severity. Basilar Artery on Computed Tomography Angiography (BATMAN) scores were used to quantify the collateral circulation, and the effect was estimated through a primary outcome of 90‐day functional independence (modified Rankin Scale score, mRS ≤2). Favorable versus unfavorable BATMAN scores were analyzed as both continuous and categorical variables, and an adjusted multivariate regression model was applied. Results: Among 221 BAO patients, thrombectomy significantly improved functional independence compared to medical management in patients with favorable BATMAN scores (aOR 7.75, 95% CI 2.78–26.1), but not in those with unfavorable BATMAN scores (aOR 1.33, 95% CI 0.28–6.92; pinteraction = 0.028). When treated as a continuous variable, increased BATMAN score was found to be associated with a higher likelihood of functional independence in the thrombectomy group (aOR 1.97, 95% CI 1.44–2.81; pinteraction = 0.053). In severe stroke patients with higher BATMAN scores (National Institutes of Health Stroke Scale (NIHSS) ≥21), we identified a significant interaction for treatment effect with thrombectomy compared to medical management (pinteraction = 0.042). Conclusion: An increased BATMAN score was significantly associated with a higher probability of functional independence after thrombectomy than after medical management, particularly in patients with severe BAO. [ABSTRACT FROM AUTHOR]

Abstract Although the efficacy of mechanical thrombectomy (MT) for acute basilar artery occlusion (ABAO) has been established in two randomized controlled studies, many patients have miserable clinical outcomes after MT for ABAO. Predicting severe disability prior to the procedure might be useful in determining the appropriateness of treatment interventions. Among the ABAO cases treated at 10 hospitals between July 2014 and December 2021, 144 were included in the study, all of whom underwent MRI before treatment. A miserable outcome was defined as a modified Rankin Scale (mRS) of 5–6 at 3 months. The associations between clinical, imaging, and procedural factors and miserable outcomes were evaluated. A miserable outcome was observed in 54 cases (37.5%). Multivariate analysis identified the National Institutes of Health Stroke Scale (NIHSS), transverse diameter of brainstem infarction, and symptomatic intracerebral hemorrhage as independent factors associated with miserable outcomes, with cutoff values of NIHSS 22 and transverse diameter of brainstem infarction 15 mm. Cases with a higher preoperative severity may result in miserable postoperative outcomes. Particularly, the transverse diameter of a brainstem infarction can be easily measured and serves as a useful criterion for determining treatment indications.

Xiangping Cheng,1,2,&ast; Boyu Chen,3,&ast; Xiaoyan Chen,4,&ast; Zhi Song,2 Jie Li,2 Jiacheng Huang,4 Weilin Kong,4 Jinglun Li1 1Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, People’s Republic of China; 2Department of Neurology, The Gulin People’s Hospital, Luzhou, Sichuan Province, People’s Republic of China; 3Department of Cerebrovascular Diseases, Qujing No. 1 Hospital, Qujing, Yunnan, People’s Republic of China; 4Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinglun Li, Department of Neurology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou City, Sichuan Province, 646000, People’s Republic of China, Email ljl031611@163.com Weilin Kong, Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), No. 183 Xinqiao Main Street, Shapingba District, Chongqing, 400037, People’s Republic of China, Email kongweilin96@whu.edu.cnPurpose: Renal impairment (RI) is associated with unfavourable outcome after acute ischaemic stroke with anterior circulation large vessel occlusion. We assessed the association of RI with clinical outcomes in patients with acute basilar artery occlusion (ABAO), and the impact of RI on the effects of endovascular therapy (EVT) versus standard medical treatment (SMT).Patients and Methods: We used data from the BASILAR registry, an observational, prospective, nationwide study of patients with ABAO in routine clinical practice in China. Baseline estimated glomerular filtration rate (eGFR) was recorded at admission. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included favourable outcome (mRS score 0– 3), mortality, and symptomatic intracranial haemorrhage (sICH). Multivariate logistic regression was used to assess the association of RI with mortality and functional improvement at 90 days.Results: Among 829 patients enrolled, 747 patients were analysed. The median baseline eGFR was 89 mL/min/1.73m2 (IQR, 71– 100), and 350 (46.8%), 297 (39.8%), and 100 (13.4%) patients had baseline eGFR values of ≥ 90, 60– 89, and < 60 mL/min/1.73m2, respectively. RI was associated with increased mortality (adjusted odds ratio [aOR], 1.97; 95% CI, 1.15– 3.67) at 90 days and decreased survival probability (aOR 1.74; 95% CI, 1.30– 2.33) within 1 year. EVT was associated with better functional improvement (common aOR, 2.50; 95% CI, 1.43– 4.35), favourable outcome (aOR 5.42; 95% CI, 1.92– 15.29) and lower mortality (aOR 0.47; 95% CI, 0.25– 0.88) in ABAO patients with eGFR ≥ 90 mL/min/1.73m2. However, RI was not modified the relationship of EVT with functional improvement (common aOR, 3.03; 95% CI, 0.81– 11.11), favourable outcome (aOR 2.10; 95% CI, 0.45– 9.79), and mortality (aOR 0.56; 95% CI, 0.15– 2.06) by eGFR categories.Conclusion: RI is associated with reduced efficacy of EVT and worse functional outcome and higher mortality at 3 months and lower survival probability at 1 year in patients with ABAO.Keywords: ischemia stroke, basilar artery occlusion, renal impairment, endovascular therapy, glomerular filtration rate

Objectives: Few experiences on vertebrobasilar occlusion over underlying intracranial atherosclerotic disease have been reported in literature and the optimal strategy on how to perform a mechanical thrombectomy is unclear. The aim of this paper is to bring our experience based on patients admitted with acute vertebrobasilar occlusion with underlying atheromatous lesions. Materials and Methods: Several data were collected from August 2009 to October 2022 including clinical history, pre- and post-treatment neurological objectivity, diagnostic images and angiographic procedural images, and clinical outcome at 6 months. We selected 13 patients from August 2009 to October 2022, 12 men and 1 woman, aged 40 to 82 years (mean age, 62.6 years). Results: Mechanical thrombectomy with a thromboaspiration was performed in all patients as beginning of the procedure. In three patients, the procedures resulted in excellent angiographic result and clinical outcome, while in three patients, we observed a failure of the procedural and clinical outcome. For residual intracranial stenosis in three patients, an angioplasty was performed obtaining an ischemic area related to the posterior circulation. In four patients, a stent was placed, in three patients, we obtained a good clinical outcome with a mRS between 0 and 2, while one treatment resulted in death, probably due to a late endovascular treatment. Conclusions: Endovascular treatment with stent deployment appears to result in an excellent outcome in patients with occlusion of the vertebrobasilar circulation in cases of occlusion on atheromatic plaque. The degree of residual stenosis after thrombospiration can significantly affect subsequent type of treatment. [ABSTRACT FROM AUTHOR]

Basilar artery occlusion (BAO) is a neurological emergency associated with a high risk for adverse outcomes. This review provides evidence on the therapeutic efficacy of intravenous thrombolysis (IVT) and endovascular therapy (EVT) in the treatment of BAO. Historically considered the primary intervention for acute ischemic stroke, IVT has been progressively combined with EVT, which has emerged from recent studies demonstrating clinical benefits, notably in patients presenting with severe stroke. Several randomised controlled trials have shown that EVT improves patient outcomes in select clinical contexts. Future research directions could address therapeutic treatment thresholds, combination strategies, and long-term outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate whether the “weekend eect” would aect the time metrics and the prognosis of acute ischemic stroke (AIS) patients who underwent endovascular treatment (EVT) due to basilar artery occlusion (BAO). Methods: Clinical data of AIS patients who underwent EVT due to BAO between December 2019 and July 2023 were retrospectively analyzed. At the time when the patients were admitted, the study population was divided into the weekdays daytime group and weekends nighttime group. In the subgroup analysis, the study cohort was divided into four groups: the weekdays daytime group, weekdays nighttime group, weekend daytime group, and weekend nighttime group. A good outcome was defined as a modified Rankin Scale score of ≤3 at 90 days after EVT. Time metrics [e.g. onset-to-door time (ODT) and door-topuncture time (DPT)] and clinical outcomes were compared using appropriate statistical methods. Results: A total of 111 patients (88 male patients, mean age, 67.7 ± 11.7 years) were included. Of these, 37 patients were treated during weekdays daytime, while 74 patients were treated during nights or weekends. There were no statistically significant differences in ODT (P = 0.136), DPT (P = 0.931), and also clinical outcomes (P = 0.826) between the two groups. Similarly, we found no significant differences in the time metrics and clinical outcomes among the four sub-groups (all P > 0.05). Conclusion: This study did not reveal any influence of the “weekend effect” on the time metrics and clinical outcomes in AIS patients who underwent EVT due to BAO at a comprehensive stroke center. [ABSTRACT FROM AUTHOR]

Background Studies on basilar artery occlusion are relatively few compared with those of anterior circulation stroke. The aim of the present study was to compare the efficacy of endovascular therapy (EVT) in patients with basilar artery occlusion classified as large artery atherosclerosis (LAA) and cardioembolism (CE), and to analyze the independent risk factors affecting the prognosis of EVT. Methods A total of 123 people were assigned to the LAA and CE groups (97 to the LAA and 26 to the CE). The primary outcome was a modified Rankin Scale (mRS) score of 2 or lower at 90 days. The primary safety outcome was mortality at 90 days. Secondary safety endpoints included the rates of symptomatic intracranial hemorrhage and reinfarction. Multiple logistic regression was used to screen out independent risk factors for EVT prognosis of the LAA and CE groups. Results In the analysis, the patients with LAA stroke had better collateral circulation (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology [SIR] score of 2–4; 61.9 vs. 19.2%, p = 0.000), and higher angioplasty rate (32.0 vs. 3.8%, p = 0.002). The proportions of patients with a 90-day mRS score of 0 to 2 and 90-day mortality were not found to be statistically significant between the two groups. Multivariate logistic regression analysis indicated that age, SIR, white blood cell, blood glucose, and modified thrombolysis in cerebral infarction were independent risk factors for the poor prognosis of EVT in the LAA group. Conclusion Although there were differences in clinical characteristics and imaging features between LAA and CE, there was no evidence of a significant difference in prognosis after EVT. In addition, the National Institutes of Health Stroke Scale score was not among the independent risk factors affecting the prognosis of the LAA group. [ABSTRACT FROM AUTHOR]

Zekun Wang, Kangxiang Ji, Qi Fang Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of ChinaCorrespondence: Zekun Wang; Qi Fang, Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Gusu District, Suzhou, Jiangsu Province, 215031, People’s Republic of China, Tel +86-512-67972207, Email superzekun@126.com; fangqi_008@126.comBackground: Futile recanalization (FR) remains a significant challenge in patients with acute basilar artery occlusion (BAO) following successful endovascular treatment (EVT). This study aimed to investigate the predictive value of computed tomography perfusion (CTP)-based software (AutoMIStar; Apollo) for FR among BAO patients undergoing EVT.Methods: We analyzed a prospectively maintained database to identify consecutive BAO patients who achieved successful recanalization (modified Thrombolysis in Cerebral Infarction grade ≥ 2b) after EVT between January 2020 and September 2022. Clinical characteristics and imaging parameters from non-contrast CT, CT angiography, and CTP-AutoMIStar were collected for analysis. FR was defined as an unfavorable outcome (modified Rankin Scale score > 3) at 90 days despite successful recanalization. Multivariable stepwise logistic regression analysis was performed to identify independent predictors of FR.Results: Of the 54 patients included in this study, 24 (44.4%) experienced FR. In the univariate analysis, admission National Institutes of Health Stroke Scale score, posterior circulation Acute Stroke Prognosis Early CT Score, Basilar Artery on Computed Tomography Angiography (BATMAN) score, hypoperfusion intensity ratio, and perfusion deficit volume in delay time (DT) > 4 s, DT > 6 s, DT > 8 s, and all cerebral blood flow (CBF) thresholds were associated with FR (all P < 0.05). In the multivariate analysis, perfusion deficit volume in CBF < 35% (adjusted odds ratio [aOR] = 1.105, 95% confidence interval [CI]: 1.004– 1.215; P = 0.040) and BATMAN score (aOR = 0.662, 95% CI: 0.455– 0.964; P = 0.031) remained independent predictors of FR.Conclusion: Perfusion deficit volume in CBF < 35% on CTP-AutoMIStar imaging maps and BATMAN score are independent predictors of FR after EVT in BAO patients. There is a significant positive correlation between perfusion deficit volume in CBF < 35% and the occurrence of FR.Keywords: acute ischemic stroke, basilar artery occlusion, endovascular treatment, cerebral blood flow, computed tomography perfusion, futile recanalization

Randomized controlled trials (RCTs) have demonstrated powerful efficacy of endovascular thrombectomy (EVT) for large vessel occlusion in the anterior circulation. The effect of EVT for acute basilar artery occlusion (BAO) in the posterior circulation remains unproven. Here, we highlight the latest findings of observational studies and RCTs of EVT for BAO, with a focus on the predictors of functional outcomes, the limitations of recent RCTs, and critical thinking on future study design. Pooled data from large retrospective studies showed 36.4% favorable outcome at 3 months and 4.6% symptomatic intracranial hemorrhage (sICH). Multivariate logistic regression analysis revealed that higher baseline NIHSS score, pc-ASPECTS

Introduction and purpose: Basilar artery occlusion (BAO) is still one of the most devastating neurological conditions associated with high morbidity and mortality. In the present study, we aimed to assess the role of posterior circulation collaterals as predictors of outcome in the BASICS trial and to compare two grading systems (BATMAN score and PC-CS) in terms of prognostic value. Methods: We performed a sub-analysis of the BASICS trial. Baseline clinical and imaging variables were analyzed. For the imaging analysis, baseline CT and CTA were analyzed by a central core lab. Only those patients with good or moderate quality of baseline CTA and with confirmed BAO were included. Multivariable binary logistic regression analysis was used to test the independent association of clinical and imaging characteristics with a favorable outcome at 3 months (defined as a modified Rankin Score of =3). ROC curve analysis was used to assess and compare accuracy between the two collateral grading systems. Results: The mean age was 67.0 (±12.5) years, 196 (65.3%) patients were males and the median NIHSS was 21.5 (IQR 11-35). Median NCCT pc-ASPECTS was 10 (IQR10-10) and median collateral scores for BATMAN and PC-CS were 8 (IQR 7-9) and 7 (IQR 6-8) respectively. Collateral scores were associated with favorable outcome at 3 months for both BATMAN and PC-CS but only with a modest accuracy on ROC curve analysis (AUC 0.62, 95% CI [0.55-0.69] and 0.67, 95% CI [0.60-0.74] respectively). Age (OR 0.97, 95% CI [0.95-1.00]), NIHSS (OR 0.91, 95% CI [0.89-0.94]) and collateral score (PC-CS - OR 1.2495% CI [1.02-1.51]) were independently associated with clinical outcome. Conclusion: The two collateral grading systems presented modest prognostic accuracy. Only the PC-CS was independently associated with a favorable outcome at 3 months. [ABSTRACT FROM AUTHOR]

We report the case of a young male patient who presented to our emergency department complaining of a transient headache and a feeling of motor impairment in his right lower limb, both of which completely resolved spontaneously. After a few minutes of his arrival, he developed a locked-in sensation with anxiety and agitation, followed by a rapid onset of left facio-brachio-crural hemisyndrome. Contrast-enhanced CT of the brain and neck showed the occlusion of the proximal-intermediate basilar artery. Acute basilar artery occlusion (BAO) is a rare life-threatening stroke that requires prompt diagnosis and appropriate treatment to avoid rapid fatal complications (coma and death). The prognosis is poor, with long-lasting sequelae in the survivors. The diagnosis is often difficult since BAO accounts for only 1% of all strokes, and the prodromal symptoms are often very mild, transient, and non-specific, such as nausea, dizziness, headache, confusion, and vertigo. In the presence of convulsion-like symptoms or an unexplained altered level of consciousness, emergency physicians should always consider BAO in the differential diagnosis.

Background: There is no established opinion regarding embolization of asymptomatic traumatic vertebral artery injuries that do not require cervical spine repair and fixation. Case Description: A 78-year-old man fell backward from a height of about 1 m and was rushed to his previous hospital. He had a fracture of the left transverse process of the 6th cervical vertebra. Six hours after the trauma, he became unconscious; magnetic resonance angiography showed occlusion of the left vertebral and basilar arteries, and he was transferred to our hospital. The basilar artery was completely recanalized 430 min after the onset of unconsciousness. Due to the presence of thrombi in the distal vertebral artery at the level of the 6th cervical vertebra and collateral blood flow from the deep cervical artery, the distal vertebral artery was occluded to prevent embolism. Postoperative diffusion-weighted imaging showed extensive infarction in the posterior circulation, and the patient died two days after surgery. Conclusion: In the case of vertebral artery injury, preparation for early occlusion of the basilar artery is necessary. If a thrombus and collateral blood flow are present distal to the vertebral artery injury, distal vertebral artery embolization may be necessary to prevent embolism. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to investigate the impact of angiographic thrombus surface morphology on the angiographic and clinical outcomes of basilar artery occlusion (BAO). Methods: This retrospective study included 141 patients with acute BAO who underwent mechanical thrombectomy (MT). We categorized thrombus surface phenotypes as either regular (smooth and straight, either convex or concave) or irregular. Patients with BAO were grouped based on the presence of a regular or irregular phenotype, and we compared their angiographic and clinical outcomes. Results: In total, 52.5% (74/141) of acute BAO patients exhibited a regular thrombus morphology. These patients had a higher rate of first-pass effect (28.4% vs. 4.5%, p = 0.0002) and fewer retrieval attempts (2 vs. 2; p = 0.0198) compared to those with irregular morphology. Among patients treated with contact aspiration (CA), the regular thrombus morphology showed a higher first-pass success rate (45.7% vs. 12.8%; p = 0.0017), a shorter procedural duration (46 vs. 50 min; p = 0.0159), and fewer retrieval attempts (1 vs. 2; p = 0.0338) compared to stent retriever (SR) thrombectomy. Both the regular thrombus morphology (OR 7.72, 95% CI 2.02-29.52; p = 0.003) and using CA as the first-line treatment (OR 3.37, 95% CI 1.12-10.13; p = 0.031) independently predicted first-pass success. Conclusion: For BAO patients treated with CA as the primary strategy, the presence of a regular thrombus surface might predict higher first-pass success and shorter procedural duration. A diligent assessment of thrombus morphology within the MT workflow could improve the feasibility of procedural techniques. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the performance of the Critical Area Perfusion Score (CAPS), based on computed tomography perfusion (CTP) time to maximum (Tmax) > 10s maps, to predict the outcome in acute basilar artery occlusion (BAO) in patients undergoing endovascular treatment (EVT). Methods: We perform a retrospective analysis of a prospectively collected database of acute BAO treated with EVT in a comprehensive stroke center. The favorable outcome was defined as the 90-day modified Rankin Scale (mRS) ≤ 3. We performed the logistic regression analysis to find the independent predictors of the favorable outcome. Then, we used receiver operating characteristic analyses to assess the predictive value of the imaging parameters, including CAPS, Posterior Circulation Alberta Stroke Program Early CT Score (PC-ASPECTS), pons midbrain index (PMI), posterior circulation computed tomography angiography (PC-CTA) score, Basilar Artery on Computed Tomography Angiography (BATMAN) score, and CTP parameters. Finally, the Delong test was used to compare the area under the curve (AUC) of CAPS against the other imaging parameters. Results: Of the 65 enrolled patients, the incidence of the favorable outcome was 44.6% (29/65). Low CAPS (per 1- point increased odds ratio [OR], 0.43; 95% confidence interval [CI], 0.22–0.86; P = 0.017) and admission National Institutes of Health Stroke Scale (NIHSS) (per 1- point increased OR, 0.80; 95% CI, 0.70–0.91; P = 0.001) were independently associated with favorable outcome. The AUC of CAPS was 0.83 (95% CI, 0.74–0.93; P < 0.001) with ≤ 3 cut-off value, 89.66% sensitivity, 77.22% specificity, and 80.00% accuracy, which was greater than the other imaging parameters (All P for Delong test < 0.05). Conclusions: CAPS was the most accurate imaging-based outcome predictor in acute BAO patients. Future large prospective multicenter studies are needed to verify these results. [ABSTRACT FROM AUTHOR]

Basilar artery occlusion (BAO) is an infrequent but often fatal subtype of stroke. Predicting outcomes and selecting patients for endovascular therapy (EVT) remains challenging. Advances in neuroimaging and the development of prognostic scoring systems have augmented clinical decision-making over time. Recent randomized trials, BEST (Basilar Artery Occlusion Endovascular Intervention vs. Standard Medical Treatment), BASICS (Basilar Artery International Cooperation Study), BAOCHE (Basilar Artery Occlusion CHinese Endovascular Trial) and ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion), compared EVT and medical management for patients with BAO. These trials yielded mixed results. The former two suggested unclear benefit while the latter two supported a benefit of EVT. While all had limitations, most providers agree caution should be exercised when excluding patients from EVT who may stand to benefit. Further studies are therefore needed to determine the effectiveness, safety, selection criteria, and optimal technical approach for EVT among patients with BAO. Hyperacute-phase advanced imaging can offer several benefits to aid decision making. It is reasonable to exclude patients with low National Institutes of Health Stroke Scale (NIHSS), large imaging-proven cores, and evidence of perforator occlusion by branch atheromatous disease. Herein, we review the clinical presentation, imaging work-up, treatments, and clinical outcomes for BAO, while highlighting knowledge gaps in treatment selection and technique. [ABSTRACT FROM AUTHOR]

Background: The evidence of mechanical thrombectomy (MT) in basilar artery occlusion (BAO) was limited. This study aimed to develop dynamic and visual nomogram models to predict the unfavorable outcome of MT in BAO online. Methods: BAO patients treated with MT were screened. Preoperative and postoperative nomogram models were developed based on clinical parameters and imaging features. An independent dataset was collected to perform external validation. Web‐based calculators were constructed to provide convenient access. Results: A total of 127 patients were included in the study, and 117 of them were eventually included in the analysis. The nomogram models showed robust discrimination, with an area under the receiver operating characteristic (ROC) of 0.841 (preoperative) and 0.916 (postoperative). The calibration curves showed good agreement. The preoperative predictors of an unfavorable outcome were previous stroke, the National Institutes of Health Stroke Scale (NIHSS) at admission, and the posterior circulation Alberta Stroke Program Early Computed Tomography Score (pc‐ASPECTS). The postoperative predictors were previous stroke, NIHSS at 24 h, and pc‐ASPECTS. Conclusion: Dynamic and visual nomograms were constructed and validated for the first time for BAO patients treated with MT, which provided precise predictions for the risk of an unfavorable outcome. The preoperative model may assist clinicians in selecting eligible patients, and the postoperative model may facilitate individualized poststroke management. [ABSTRACT FROM AUTHOR]

Introduction and purposeBasilar artery occlusion (BAO) is still one of the most devastating neurological conditions associated with high morbidity and mortality. In the present study, we aimed to assess the role of posterior circulation collaterals as predictors of outcome in the BASICS trial and to compare two grading systems (BATMAN score and PC-CS) in terms of prognostic value.MethodsWe performed a sub-analysis of the BASICS trial. Baseline clinical and imaging variables were analyzed. For the imaging analysis, baseline CT and CTA were analyzed by a central core lab. Only those patients with good or moderate quality of baseline CTA and with confirmed BAO were included. Multivariable binary logistic regression analysis was used to test the independent association of clinical and imaging characteristics with a favorable outcome at 3 months (defined as a modified Rankin Score of ≤3). ROC curve analysis was used to assess and compare accuracy between the two collateral grading systems.ResultsThe mean age was 67.0 (±12.5) years, 196 (65.3%) patients were males and the median NIHSS was 21.5 (IQR 11–35). Median NCCT pc-ASPECTS was 10 (IQR10-10) and median collateral scores for BATMAN and PC-CS were 8 (IQR 7–9) and 7 (IQR 6–8) respectively. Collateral scores were associated with favorable outcome at 3 months for both BATMAN and PC-CS but only with a modest accuracy on ROC curve analysis (AUC 0.62, 95% CI [0.55–0.69] and 0.67, 95% CI [0.60–0.74] respectively). Age (OR 0.97, 95% CI [0.95–1.00]), NIHSS (OR 0.91, 95% CI [0.89–0.94]) and collateral score (PC-CS – OR 1.2495% CI [1.02–1.51]) were independently associated with clinical outcome.ConclusionThe two collateral grading systems presented modest prognostic accuracy. Only the PC-CS was independently associated with a favorable outcome at 3 months.

Background This study aimed to establish and validate a nomogram model for predicting 90‐day mortality in patients with acute basilar artery occlusion receiving endovascular thrombectomy. Methods and Results A total of 242 patients with basilar artery occlusion undergoing endovascular thrombectomy were enrolled in our study, in which 172 patients from 3 stroke centers were assigned to the training cohort, and 70 patients from another center were assigned to the validation cohort. Univariate and multivariate logistic regression analyses were adopted to screen prognostic predictors, and those with significance were subjected to establish a nomogram model in the training cohort. The discriminative accuracy, calibration, and clinical usefulness of the nomogram model was verified in the internal and external cohorts. Six variables, including age, baseline National Institutes of Health Stroke Scale score, Posterior Circulation–Alberta Stroke Program Early CT (Computed Tomography) score, Basilar Artery on Computed Tomography Angiography score, recanalization failure, and symptomatic intracranial hemorrhage, were identified as independent predictors of 90‐day mortality of patients with basilar artery occlusion and were subjected to develop a nomogram model. The nomogram model exhibited good discrimination, calibration, and clinical usefulness in both the internal and the external cohorts. Additionally, patients were divided into low‐, moderate‐, and high‐risk groups based on the risk‐stratified nomogram model. Conclusions Our study proposed a novel nomogram model that could effectively predict 90‐day mortality of patients with basilar artery occlusion after endovascular thrombectomy and stratify patients with high, moderate, or low risk, which has a potential to facilitate prognostic judgment and clinical management of stroke.

Background Approximately half of patients who achieve successful reperfusion do not achieve functional independence. The present study sought to investigate the clinical outcomes and safety of intraarterial or intravenous tirofiban as adjunct therapy in patients with acute basilar artery occlusion who had achieved successful recanalization with endovascular treatment. Methods and Results In the national, prospective BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study) registry, 458 patients who met inclusion criteria were divided into 3 groups based on tirofiban administration (no tirofiban, n=262; intravenous tirofiban, n=101; intraarterial+intravenous tirofiban, n=95). Their clinical outcomes were compared with 90‐day modified Rankin Scale scores. Adjusted odds ratios (aORs) and 95% CIs were obtained by logistic regression models and propensity score matching. Safety outcomes included any intracranial hemorrhage (ICH), symptomatic ICH, and mortality. Among 458 included patients, 184 (40.2%) achieved a favorable outcome (modified Rankin Scale score 0–3). There were no differences between the intravenous tirofiban group and the no tirofiban group in terms of safety and clinical outcomes (all P>0.05). Compared with the no tirofiban group, the intraarterial+intravenous tirofiban group had higher odds of 90‐day modified Rankin Scale score 0 to 3 (aOR, 2.44 [95% CI, 1.30–4.64], P=0.006) and lower 3‐month mortality (aOR, 0.38 [95% CI, 0.19–0.71], P=0.002) without an increase in any ICH (aOR, 0.34 [95% CI, 0.09–1.01], P=0.07) or symptomatic ICH (aOR, 0.23 [95% CI, 0.03–0.90], P=0.05). Similar results of intraarterial+intravenous tirofiban on improving clinical outcomes were detected in novel cohorts constructed by propensity score matching. Conclusions Intraarterial+intravenous rather than intravenous tirofiban improved clinical outcomes without increasing the frequency of symptomatic ICH among patients with basilar artery occlusion after successful endovascular treatment. Further studies are needed to delineate the roles of intraarterial+intravenous tirofiban in patients with basilar artery occlusion receiving endovascular treatment.

Background To date it is uncertain whether the drip‐and‐ship (DS) model (transport to the nearest primary stroke centers) or the mothership (MS) model (direct transportation to the comprehensive stroke center) is the best prehospital stroke system of care to deliver endovascular thrombectomy in patients with basilar artery occlusion. In the present analysis, we aim to investigate the impact of MS versus DS model in patients with basilar artery occlusion treated with endovascular thrombectomy in the London metropolitan area. Methods This is a multicenter observational, investigator‐initiated, retrospective study comparing outcomes (functional independence, defined as modified Rankin scale scores of 0 through 2, the rate of successful reperfusion, and the rate of complications postprocedure) in DS versus MS stroke patients with basilar artery occlusion admitted in 5 thrombectomy capable centers in London (United Kingdom). Results Of 113 patients, 38 (33.6%) patients were MS and 75 (66.4%) were DS. Between the 2 groups we did not observe statistically significant differences for most of the clinical characteristics. There was a significant difference regarding the rate of functional independence at 3 months between the MS and DS groups, respectively 47.4% versus 36% (P = 0.047). Rates of complications postprocedure and successful recanalization did not differ between the 2 groups. Multivariable regression analysis demonstrated that MS model was an independent predictor of functional independence at 90 days (odds ratio [OR] 1.17; [95% CI, 1.11–1.26]; P = 0.003 and independent negative predictor of postoperative complications (OR, 0.39; [95% CI, 0.16–0.98]; P = 0.045). Conclusion Our study showed that MS model was a predictor of functional independence at 3 months and reduced risk of postoperative complications post‐endovascular thrombectomy in patients with basilar artery occlusion in a metropolitan area.

Background and Purpose To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities. Methods This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups. Results Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; P=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; P=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]). Conclusion In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.

Objective: Giant aneurysms are infrequently complicated with obstructive hydrocephalus (HC), however, when concurrent, effective treatments are unestablished. There are incredibly few reports of HC due to basilar artery giant aneurysms and fewer reports regarding ventriculoperitoneal (VP) shunt complications in these patients. Case presentation: We report the case of a gentleman in his 70 s who presented with a fusiform aneurysm of the entire basilar artery and mild intra-aneurysmal thrombosis. HC, secondary to the aneurysm, indicated VP shunt placement. Within 12 h following shunt placement, however, the patient deteriorated rapidly due to complete basilar artery occlusion and widespread brainstem ischemia. Endovascular intervention was unsuccessful due to extremely high clot burden. He unfortunately expired 2 days afterwards. Conclusion: Hydrocephalus due to aneurysms is not uncommon, and VP shunt placement should be optimized to avoid unforeseen complications like the one described. We suspect that the shunt placement aggravated the already aberrant flow within the aneurysm, propagating a pro-thrombotic environment. With further reports of this complication, a standardized method to place VP shunts for patients with giant aneurysms while minimizing the risk of thrombotic occlusion could be established.

Background The presence of sudden onset to maximal deficit (SOTMD) in patients with acute basilar artery occlusion often results in more severe outcomes. However, the effect of endovascular therapy on SOTMD and whether the outcome is affected by onset‐to‐puncture time remain unclear. Methods and Results This retrospective analysis was conducted using data from the prospective BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry). Consecutive patients with basilar artery occlusion receiving endovascular therapy were dichotomized into SOTMD and non‐SOTMD cohorts. The primary outcomes included a favorable outcome (modified Rankin scale 0–3), recanalization, and mortality at 90 days. The outcomes of patients with SOTMD were analyzed using multivariable logistic regression. In the multivariate analysis, a favorable outcome was similar between the two cohorts (odds ratio [OR], 0.88 [95% CI, 0.58–1.34]; P=0.5), although the mortality of patients with SOTMD was higher than that of patients with non‐SOTMD (OR, 1.67 [95% CI, 1.14–2.44]; P=0.008). The probability of mortality increased from 40.0% at 1 hour to 70.0% at 6 hours in the SOTMD cohort, and favorable outcomes of patients with non‐SOTMD declined from 38.0% at 1 hour to 18.0% at 8 hours. Conclusions No significant difference was observed in favorable outcomes between the SOTMD and non‐SOTMD groups, although mortality was higher in the SOTMD cohort. The patients with SOTMD had a stronger time dependence for endovascular therapy in terms of mortality, while the time dependency regarding favorable outcome in the NSOTMD group was even higher. Registration URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1800014759.

Background Vascular tortuosity affects the outcomes of mechanical thrombectomy (MT). We classified vertebral artery (VA) tortuosity into 3 types and investigated the effect of VA tortuosity on the outcomes in patients with basilar artery occlusion. Methods We retrospectively included patients who underwent MT for basilar artery occlusion between January 2012 and May 2022. Clinical and procedure‐related factors were obtained. VA tortuosity was classified into 3 types: type I: nontortuous VA; type II: S‐shaped vessel or a VA with a single acute angulation (1 location. The 3‐month modified Rankin scale, procedural outcomes, and post‐MT intracranial hemorrhage were assessed. Results A total of 106 patients with basilar artery occlusion were included. Age, baseline stroke severity, and 3‐month modified Rankin scale score were significantly different according to VA tortuosity (P = 0.003, P = 0.002, and P

BackgroundFew studies have focused on factors associated with futile recanalization in patients with an acute basilar artery occlusion (BAO) that was treated with modern endovascular therapy (EVT). The aim of this study was to explore the factors associated with futile recanalization in patients with an acute BAO presented within 12 h.MethodsThis is a post-hoc analysis of the ATTENTION trial (The Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion, ClinicalTrials.gov, number NCT 04751708). Demographics, clinical characteristics, acute stroke workflow interval times, and imaging characteristics were compared between the futile recanalization and favorable recanalization groups. The favorable outcome was defined as a modified Rankin scale (mRS) score of 0–3 at 90 days, successful reperfusion was defined as thrombolysis in cerebral infarction (TICI) 2b and 3 on the final angiogram, and futile recanalization was defined as failure to achieve a favorable outcome despite successful reperfusion. A multivariate analysis was performed to identify the predictors of futile recanalization.ResultsIn total, 185 patients were included in the final analysis: 89 (48.1%) patients had futile recanalization and 96 (51.9%) patients had favorable recanalization. In the multivariable logistic regression analysis, older age (OR 1.04, 95% CI 1.01 to 1.08, p = 0.01) and diabetes mellitus (OR 3.35, 95% CI 1.40 to 8.01, p = 0.007) were independent predictors of futile recanalization.ConclusionFutile recanalization occurred in nearly half of patients with acute BAO following endovascular treatment. Old age and diabetes mellitus were identified as independent predictors of futile recanalization after endovascular therapy for acute BAO.

Abstract Background The evidence of mechanical thrombectomy (MT) in basilar artery occlusion (BAO) was limited. This study aimed to develop dynamic and visual nomogram models to predict the unfavorable outcome of MT in BAO online. Methods BAO patients treated with MT were screened. Preoperative and postoperative nomogram models were developed based on clinical parameters and imaging features. An independent dataset was collected to perform external validation. Web‐based calculators were constructed to provide convenient access. Results A total of 127 patients were included in the study, and 117 of them were eventually included in the analysis. The nomogram models showed robust discrimination, with an area under the receiver operating characteristic (ROC) of 0.841 (preoperative) and 0.916 (postoperative). The calibration curves showed good agreement. The preoperative predictors of an unfavorable outcome were previous stroke, the National Institutes of Health Stroke Scale (NIHSS) at admission, and the posterior circulation Alberta Stroke Program Early Computed Tomography Score (pc‐ASPECTS). The postoperative predictors were previous stroke, NIHSS at 24 h, and pc‐ASPECTS. Conclusion Dynamic and visual nomograms were constructed and validated for the first time for BAO patients treated with MT, which provided precise predictions for the risk of an unfavorable outcome. The preoperative model may assist clinicians in selecting eligible patients, and the postoperative model may facilitate individualized poststroke management.

Background: Ischemic stroke caused by basilar artery occlusions (BAOs) poses a risk for misdiagnosis, leading to an increase the rates of mortality and disability, particularly in low-, and middle-income countries. Methods: A retrospective and cross-sectional study evaluated 21 patients with an initial misdiagnosis of BAO among 110 BAO patients from 7 district hospitals who were subsequently admitted to the stroke center at the 103 Military Hospital from June 2021 to September 2022 in Ha Noi city, Vietnam. Patient data collected were age, sex, medical history, initial diagnosis, neuroradiologic findings, and treatment outcome at 1 month after hospital discharge. Results: The rate for misdiagnosis for BAOs in the initial emergency department (ED) was 19.1%. The average patient age was 68.9 (63–81) years. The most common symptom at the disease onset was dizziness, followed by altered consciousness, seizures, quadriplegia, hemiplegia, functional swallowing disorder, and breathing disorders. Vestibular disorder was the most common misdiagnosis of BAOs, followed by epilepsy, hypoglycemia, and delirium tremens, impaired consciousness with unknown cause, polyneuritis, and aspiration pneumonia. Cerebral infarction was not detected in all brain computed tomography images, but was detected in brain magnetic resonance images. The average score of the Modified Rankin Scale was 5.4 ± 0.5, and 47.6% of the patients who died after 1 month from the hospital discharge. Conclusion: Misdiagnosis of BAOs at the initial ED visit resulted in serious consequences. We highly recommend the use of brain magnetic resonance imaging as the preferred imaging method for patients with suspected BAOs who present to the ED.All authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. All authors have read and approved the final submitted revised manuscript.

Objective: This narrative review discusses posterior circulation cerebral infarcts (PCCI) and provides an update given recent randomized trials in the management of basilar artery occlusion (BAO). We examine clinical characteristics, imaging protocols, management updates, and outcomes of PCCI. Methods: The following databases were searched: MEDLINE, Scopus, Google Scholar, and Web of Science for articles on PCCI. We included randomized trials and observational studies in humans. We also reviewed relevant references from the literature identified. Results: PCCI and BAO is associated with high morbidity and mortality. Early assessment and accurate diagnosis of PCCI remains a clinical challenge. Neuroimaging advances have improved early detection, but barriers remain due to costs and availability. Recent randomized trials provide new insights for BAO patients and support the efficacy of endovascular thrombectomy. Discussion: PCCI requires specific diagnostic and management that is distinct from anterior circulation stroke. While further studies are needed in varied populations and in the subset of BAO patients presenting with milder deficits, growing randomized data support the treatment of BAO patients with endovascular thrombectomy.

Objective: This study aimed to investigate the efficacy and economic effect of endovascular treatment (EVT) combined with standard medical treatment (SMT) vs. SMT alone in Chinese patients with basilar artery occlusion (BAO) from the perspective of the Chinese healthcare system. Methods: We conducted a cost-effectiveness analysis using the results from a meta-analysis comparing EVT and SMT efficacy in Chinese patients with BAOinduced stroke using direct medical costs from the China National Stroke Registry. The meta-analysis's primary outcome was excellent functional outcome (mRS scores of 0-2), with secondary outcomes being poor functional outcome (mRS scores of 3-5) and death (mRS score of 6). To compare EVT plus SMT's cost-effectiveness with that of SMT alone, we constructed a combined decision tree and Markov model with a lifetime duration and a 3-month cycle length. The primary cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER), representing the incremental cost per incremental quality-adjusted life year (QALY). EVT was considered cost-effective if the ICER was lower than the willingness-to-pay (WTP) threshold of three times the per capita gross domestic product (GDP) in 2021 in China; otherwise, it would not be cost-effective. Results: The meta-analysis results indicated that EVT could increase the incidence of excellent functional outcomes, with a risk ratio (RR) of 2.23 (95% confidence interval, CI, 1.18-4.21), p = 0.01. Simultaneously, EVT reduced the risk of poor functional outcome and mortality in the EVT group, with RRs of 0.83 (95% CI, 0.67-1.03), p = 0.09, and 0.71 (95% CI, 0.59-0.85), p = 0.0002, respectively. The study also found that EVT plus SMT resulted in a lifetime effectiveness of 2.15 QALY (3.88 life years) for 32,213 international dollars (Intl.$) per patient with BAO. In contrast, SMT alone achieved an effectiveness of 1.46 QALY (3.03 life years) with a total cost of Intl.$ 13,592 per patient. The ICER was Intl.$ 27,265 per QALY (Intl.$ 22,098 per life-year), which fell below the WTP threshold. Conclusion: Compared to SMT, EVT improves the prognosis of BAO-induced stroke. Considering the Chinese healthcare system, adding EVT to SMT proves to be cost-effective for patients with BAO compared to SMT alone. [ABSTRACT FROM AUTHOR]

Background: Although endovascular treatment (EVT) is beneficial for large vessel occlusion in anterior circulation stroke, whether these benefits exist for basilar artery occlusion (BAO) remains unclear. This systematic review and meta-analysis compared the outcomes of patients with BAO undergoing EVT and standard medical treatment (SMT). Methods: The PubMed, Embase, and Cochrane Library databases were searched for eligible randomized control trials (RCTs) and non-RCTs involving patients with acute ischemic stroke and BAO undergoing EVT or SMT. The following outcomes were assessed: 90-day functional outcomes (favorable outcome and functional independence: modified Rankin scale [mRS] score of 0–3 or 0–2, respectively), mortality, and symptomatic intracranial hemorrhage (sICH) incidence. The summary effect sizes were determined as risk ratios (RRs) through the Mantel–Haenszel method with a random-effects model. Results: Four RCTs and four non-RCTs were included. Compared with SMT, EVT resulted in a higher proportion of patients with 90-day mRS scores of 0–3 (RR: 1.54 [1.16–2.06] in RCTs and 1.88 [1.11–3.19] in non-RCTs), a higher proportion of patients achieving functional independence (90-day mRS score of 0–2; RR: 1.83 [1.07–3.12] and 1.84 [0.97–3.48], respectively), a lower risk of mortality (RR: 0.76 [0.65–0.89] and 0.72 [0.62–0.83], respectively), and a higher sICH risk (RR: 5.98 [2.11–16.97] and 4.95 [2.40–10.23], respectively). Severe neurological deficits, intravenous thrombolysis, and higher posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS) were associated with EVT benefits. Conclusion: In patients with BAO, EVT results in superior functional outcomes, lower mortality risk, and higher sICH risk than does SMT, independent of age and sex. Higher National Institutes of Health Stroke Scale scores, intravenous thrombolysis, and higher pc-ASPECTSs before treatment are associated with greater benefits from EVT. [ABSTRACT FROM AUTHOR]

Background and aims: Octogenarians are underrepresented in recently published studies that showed the benefit of endovascular stroke treatment (EST) for patients with acute basilar artery occlusion (BAO). We aimed to compare the clinical outcome of octogenarians with BAO and EST compared to younger patients (YPs) and identify independent outcome predictors. Methods: This is a retrospective, single-center analysis of patients treated for BAO with EST from January 2013 until June 2021 in a tertiary stroke center. Octogenarians (80-89 years) were compared to YPs. A study endpoint was a favorable clinical outcome as per the modified Rankin Scale (mRS 0-3), 90 days after stroke onset. The study groups were compared using univariate analysis, and a multivariable logistic regression analysis was performed to define independent predictors for favorable and unfavorable (mRS 5-6) clinical outcomes. Results: In this study cohort, 74/191 (38.7%) octogenarians had a higher pre-stroke mRS [median, interquartile range (IQR): 2, 1-3 octogenarians vs. 0, 0-1 YP, p < 0.001] and a comparable National Institutes of Health Stroke Scale (NIHSS) before EST (median, IQR: 21, 10-38 vs. 20, 8-35 in YP, p = 0.487). They showed a comparable rate of favorable outcome (mRS 0-3, 90 days, 23.0 vs. 25.6% in YP, p = 0.725), but were less often functionally independent (mRS 0-2: 10.8% in octogenarians vs. 23.0% in YP, p = 0.049). The rate of unfavorable clinical outcome was comparable (mRS 5-6, n = 40, 54.1% in octogenarians vs. n = 64, 54.7% in YP, p = 0.831). A baseline NIHSS was an independent predictor for clinical outcome in YPs [e.g., for unfavorable clinical outcome: odds ratio (OR) 1.061, confidence interval (CI) 1.027-1.098, p = 0.005] and for favorable clinical outcome in octogenarians. Pre-stroke mRS predicted favorable outcomes in octogenarians (OR 0.54, CI 0.30-0.90, p = 0.0291), while age predicted unfavorable outcomes in YPs (OR 1.045, CI 1.011-1.086, p = 0.0137). Conclusion: Octogenarians with acute BAO eligible for EST are as likely to achieve a favorable outcome as YPs, and the rate of death or severe disability is comparable. The admission NIHSS is an independent predictor for favorable and unfavorable outcomes in YP and for favorable outcomes in octogenarians. In this study cohort, pre-stroke mRS predicted favorable outcomes in octogenarians while age predicted an unfavorable outcome in YPs. [ABSTRACT FROM AUTHOR]

Objective: Basilar artery occlusion (BAO) is an infrequent form of acute life-threatening stroke and may occur secondary to vertebral artery dissection (VAD). VAD, which occurs spontaneously and sometimes results from mechanical stress or blunt force trauma to the neck, sometimes occurs in the V1-V2 junction, but there are not many reported cases of those. Herein, we report a pictorially illustrative and clinically informative case of VAD in the V1-V2 junction following BAO. Case Presentation: The patient was a 27-year-old woman who was transferred to our hospital with abrupt severe unconsciousness. On admission, she presented with generalized convulsions and respiratory arrest, and pan-scan CT and CTA indicated BAO. We performed mechanical thrombectomy and achieved recanalization of the basilar artery, and she was diagnosed with BAO secondary to the right VAD at the entry of the C6 transverse foramen (V1-V2 junction). In hindsight, she had scapula and back pain before the onset. She recovered with a modified Rankin scale score of 3 after 90 days from the onset. Conclusion: VAD sometimes occurs at its entry into the transverse foramen of the C6 vertebra. In this case, VAD may be affected by minor trauma and potentially histological fragility due to the embryonic development process. Although BAO is sometimes difficult to diagnose because it presents with various symptoms, BAO secondary to VAD should be considered in cases of abrupt severe unconsciousness preceded by neck, scapula, or back pain in young and healthy persons. [ABSTRACT FROM AUTHOR]

Studies have shown the benefits of endovascular treatment (EVT) in adult stroke cases, but its application in pediatric stroke remains controversial. Despite evidence of improved outcomes in adults, there are no established recommendations for EVT in children. Conducting individual case reports and case series is vital to understanding its potential advantages and disadvantages in this context. In this case report, a 9-year-old male initially diagnosed with gastroenteritis developed sudden left-sided weakness 1 day after admission. Comprehensive imaging revealed acute ischemia in the cerebellum, indicating a basilar artery thrombus. Urgent endovascular treatment (EVT) was performed 8.5 h after the onset of neurological symptoms, achieving successful revascularization. The patient underwent rehabilitation and was later discharged with improved neurological status. Despite extensive investigations, the stroke's origin remained unknown. After six months, the patient exhibited complete neurological recovery, highlighting the patient's remarkable resilience. [ABSTRACT FROM AUTHOR]

Objective: There is still insufficient evidence in the current guidelines for the endovascular treatment (EVT) of basilar artery occlusions (BAO). This study aims to investigate the factors affecting the functional outcomes and mortality of patients after basilar artery thrombectomy at 3 months. Materials and Methods: In this study, the clinical, radiological, and interventional procedural features of 22 patients who underwent basilar artery thrombectomy in our stroke center between 2016 and 2021 were evaluated retrospectively. The patients were divided into two groups according to their 3-month mortality and morbidity, and they were evaluated in terms of the statistical significance of comorbidity, BAO level and collateral status, symptom recanalization time, and general anesthesia status. Results: In the patient group with the highest 3-month mortality rate, the symptom recanalization time was found to be significantly longer (P = 0.034), whereas in the patient group with high posterior cerebral system collateral scores, 3-month functional outcomes were found to be significantly improved (P = 0.022). Conclusion: In the EVT of BAOs, the mortality rate of patients increases as the recanalization time increases, and patients with higher posterior cerebral system collateral scores are more likely to benefit from the basilar artery thrombectomy procedure.

Abstract Background Recently, the BAOCHE trial and ATTENTION trial registry have demonstrated the efficacy of endovascular treatment (EVT) in patients with acute basilar artery occlusion (BAO), however, the proportion of patients with favorable post-EVT outcomes remains low. The present study aimed to investigate the individual and joint prognostic values of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with acute BAO who have undergone EVT. Methods We enrolled patients who underwent EVT from the BASILAR registry. Patients were divided into the following groups based on their modified Rankin Scale (mRS) scores at 90 days: favorable-outcome (mRS score: 0–3) and poor-outcome (mRS score: 4–6) groups. Multivariable logistic regression was performed to analyze the association of NLR and PLR with favorable post-EVT outcomes. Results In total, 585 patients with EVT were recruited. Of these, 189 and 396 patients were in the favorable-outcome and poor-outcome groups, respectively. According to the multivariable logistic regression analyses, both NLR (adjusted odds ratio [aOR], 0.950; 95% confidence interval [CI], 0.920–0.981; P = 0.002) and PLR (aOR, 0.997; 95% CI, 0.995–0.999; P = 0.002) were related to favorable post-EVT outcomes in patients with acute BAO. The optimal cutoff values for the NLR and PLR were 7.75 and 191, respectively. Furthermore, stratified analysis using the multivariable logistic regression model revealed that both NLR and PLR (NLR values ≥ 7.75 and PLR values ≥ 191) were associated with a low rate of favorable outcomes (aOR, 0.292; 95% CI, 0.173–0.494; P

Background and aimsOctogenarians are underrepresented in recently published studies that showed the benefit of endovascular stroke treatment (EST) for patients with acute basilar artery occlusion (BAO). We aimed to compare the clinical outcome of octogenarians with BAO and EST compared to younger patients (YPs) and identify independent outcome predictors.MethodsThis is a retrospective, single-center analysis of patients treated for BAO with EST from January 2013 until June 2021 in a tertiary stroke center. Octogenarians (80–89 years) were compared to YPs. A study endpoint was a favorable clinical outcome as per the modified Rankin Scale (mRS 0–3), 90 days after stroke onset. The study groups were compared using univariate analysis, and a multivariable logistic regression analysis was performed to define independent predictors for favorable and unfavorable (mRS 5–6) clinical outcomes.ResultsIn this study cohort, 74/191 (38.7%) octogenarians had a higher pre-stroke mRS [median, interquartile range (IQR): 2, 1–3 octogenarians vs. 0, 0–1 YP, p < 0.001] and a comparable National Institutes of Health Stroke Scale (NIHSS) before EST (median, IQR: 21, 10–38 vs. 20, 8–35 in YP, p = 0.487). They showed a comparable rate of favorable outcome (mRS 0–3, 90 days, 23.0 vs. 25.6% in YP, p = 0.725), but were less often functionally independent (mRS 0–2: 10.8% in octogenarians vs. 23.0% in YP, p = 0.049). The rate of unfavorable clinical outcome was comparable (mRS 5–6, n = 40, 54.1% in octogenarians vs. n = 64, 54.7% in YP, p = 0.831). A baseline NIHSS was an independent predictor for clinical outcome in YPs [e.g., for unfavorable clinical outcome: odds ratio (OR) 1.061, confidence interval (CI) 1.027–1.098, p = 0.005] and for favorable clinical outcome in octogenarians. Pre-stroke mRS predicted favorable outcomes in octogenarians (OR 0.54, CI 0.30–0.90, p = 0.0291), while age predicted unfavorable outcomes in YPs (OR 1.045, CI 1.011–1.086, p = 0.0137).ConclusionOctogenarians with acute BAO eligible for EST are as likely to achieve a favorable outcome as YPs, and the rate of death or severe disability is comparable. The admission NIHSS is an independent predictor for favorable and unfavorable outcomes in YP and for favorable outcomes in octogenarians. In this study cohort, pre-stroke mRS predicted favorable outcomes in octogenarians while age predicted an unfavorable outcome in YPs.

Persistent hypoglossal artery (PHA) is a rare carotid-vertebrobasilar anastomosis in adults. Here, we report a case of mechanical thrombectomy for acute basilar artery occlusion via the PHA. A 44-year-old man was admitted to our stroke unit with an unstable gait and aphasia for 2 h. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 4, but the clinical symptoms continued to worsen. Computed tomography angiography showed the absence of the basilar artery and an abnormal anastomosis between the anterior and posterior circulation. Clinical symptoms continued to worsen, and endovascular treatment was scheduled. PHA was demonstrated and basilar artery occlusion was confirmed using digital subtraction angiography. Mechanical thrombectomy with a stent retriever and aspiration was performed via the PHA, and modified thrombolysis in cerebral infarction level 3 was achieved. The patient underwent intravenous antiplatelet therapy after the operation, and follow-up neuroimaging revealed multiple small infarcts in the cerebellum and medulla oblongata. The patient was discharged after 10 days for further rehabilitation, with an NIHSS score of 25. At 10 months follow-up, the NIHSS score decreased to 18. Recognition of this rare variation is particularly important for interventional strategy determination and rapid recanalization of basilar artery occlusion. [ABSTRACT FROM AUTHOR]

Introduction: Untreated basilar artery occlusion (BAO) carries 70% mortality. Guidelines recommend thrombectomy with or without thrombolysis. Aim: We compared Modified Rankin Scores (mRS) at 3 and 12 months post thrombectomy to determine benefit of long‐term follow up. Methods: Retrospective, single centre analysis of BAO thrombectomies between 2015 and 2019. Inclusion criteria were symptomatic BAO on CT angiography, absent early ischemic changes, premorbid independence and intervention within 24 h. All received stroke ward care. Results were analysed with simple statistics and binary logistic regression as appropriate. Results: Of 82 patients: most were male (61%, 50/82) with median age 68 years (IQR 17 years) and median NIHSS 14 (IQR 15). Median door‐to‐puncture time was 42 min (IQR 72 min). Total deaths were 34.1% (28/82) at 3 months, and 37.8% (31/82) at 12 months. Of 51 patients alive at 12 months: 41% (21/51) had improved mRS, 16% (8/51) had worse mRS and 43% (22/51) had unchanged mRS, compared to 3 months. Improvements to mRS were: one point in 57.1% (14/21), two points in 28.9% (6/21) and three points in 4.8% (1/21). Nursing home admission was avoided in 11.8% (6/51) who improved from mRS4. Increased age was associated with decreased likelihood of reaching the primary outcome OR 0.87, 95% CI 0.76–0.99 (p value = 0.03). Conclusion: Over a quarter of patients improved beyond 3 months. Future studies should adopt long‐term follow up as primary outcome. [ABSTRACT FROM AUTHOR]

Objective: Persistent proatlantal artery (PPA) is a primitive carotid-vertebrobasilar anastomosis (CVA); acute ischemic stroke due to basilar artery (BA) occlusion via a PPA is extremely rare. Case Presentation: An 84-year-old female developed disturbance of consciousness (Glasgow Coma Scale E2V1M5) and quadriparesis with a National Institutes of Health Stroke Scale score of 35. Head CT revealed early ischemic changes in the right temporal lobe, and a hyperdense vessel sign in the BA. Cerebral angiography showed that the left vertebral artery (VA) did not originate from the left subclavian artery or aortic arch. A left common carotid artery angiogram showed the presence of the left PPA originating from the left external carotid artery. Mechanical thrombectomy (MT) with contact aspiration using a Penumbra 5MAX ACE 60 aspiration catheter was performed, and successful recanalization was achieved after clot retrieval in the first attempt (thrombolysis in cerebral infarction scale 2b). MRI performed the following day, however, revealed a newly developed large hemorrhagic infarction in the pons, with no improvement in her symptoms (modified Rankin Scale score of 5 at 90 days). Conclusion: Although MT achieved successful recanalization of the BA via the PPA, her clinical symptoms did not improve, probably because of poor collateral circulation or the long length of the occlusion. In patients with acute vertebro-BA occlusion, if the VA does not originate from the subclavian artery or aortic arch, the presence of a primitive CVA should be considered. [ABSTRACT FROM AUTHOR]

Background & Objective: Data about outcomes of endovascular treatment (EVT) in basilar artery occlusion (BAO) are limited. The aim of this study is to evaluate the predictors of functional outcome and to investigate the benefit of bridging intravenous thrombolysis (IVT) and the impact of first-pass effect (FPE) on prognosis. Methods: A total of 57 consecutive BAO patients who received EVT at our tertiary stroke center between January 2018 and March 2021 were retrospectively analyzed. The primary outcome was to evaluate excellent prognosis (mRS 0-1) and mortality (mRS 6) at day 90. The secondary outcome was to define the benefit of bridging IVT and the impact of FPE on prognosis. The safety outcome was symptomatic intracranial hemorrhage (sICH). National Institutes of Health Stroke Scale (NIHSS) at admission and at 24 hours, collateral scores, successful recanalization, asymptomatic ICH, embolization, malignant infarction and decompression were also evaluated. Results: The mean age of the patients was 64.1 ± 14.5 years. Male-to-female ratio was 1.7. Hypertension (HT) was the most common risk factor. Bridging IVT was performed in nine patients (15.8%). The FPE rate was 56.1%. NIHSS scores at admission and at 24 hours were found to be statistically significant predictors of prognosis (P=0.023 and P<0.001, respectively). Bridging IVT, FPE, successful recanalization and collateral status did not significantly predict outcome. Conclusion: Lower NIHSS scores at admission and at 24 hours were significantly associated with excellent prognosis. NIHSS scores at admission and at 24 hours were significantly higher in mortality group. sICH did not predict mortality. [ABSTRACT FROM AUTHOR]

Acute basilar artery occlusion (BAO) may cause ischemia in the region of brainstem, parts of the thalamus, occipital lobes, and cerebellum, resulting in severe disability or mortality rate above 70%. Recurrent BAO has been described in only a small number of cases. We present a case of repeated mechanical thrombectomy (MT) for the tip of basilar artery (BA) reocclusion within 24 hours. A previously healthy 37-year-old male presented with occipital headache, nausea, vomiting, right-sided hemiparesis, within 30 minutes from the onset and NIHSS 18. The patient was vaccinated against COVID-19 with Pfizer-BioNTech vaccine seven days before the onset. On initial computed tomography (CT) scan, the pc-ASPECTS was 10 and CT angiography (CTA) showed the tip of BA thrombosis. Intravenous thrombolytic therapy was administered, followed by MT, achieving mTICI 3 and NIHSS 5 after the procedure. Within 24 hours from the first MT, there was neurological deterioration followed by coma. Urgent CT/CTA was performed and rethrombosis of BA was confirmed with pc-ASPECTS 10. MT was repeated with mTICI 2b. Stroke etiology was undetermined. After 17 days, the patient was discharged and referred to continue rehabilitation treatment. After 90 days of stroke, his NIHSS was 2 and mRS 1. We can consider that early recurrent BAO can be successfully treated with repeated MT.

目的 探索新的基底动脉影像学评分方法——基于MRA评估基底动脉闭塞预后评分（basilar artery occlusion prognosis score on magnetic resonance angiography，BAOPS-MRA）及其对非重症基底动脉闭塞患者预后的评估效果。 方法 提出基于MRA的新型基底动脉评分方法——BAOPS-MRA及其动脉节段评分标准。前瞻性连续入组2019年1月-2020年12月经头颅MRA诊断为基底动脉闭塞且NIHSS≤15分的后循环缺血性卒中患者，在该患者群体中评估BAOPS-MRA预测发病3个月功能预后的效能。根据发病3个月的随访结果，将患者分为预后良好（mRS≤2分）组和预后不良（mRS＞2分）组，基于患者入院时的MRA结果，评定BAOPS-MRA，同时评定既往研究者提出的基于MRA的基底动脉和侧支循环的评分（basilar artery and collateration score on magnetic resonance angiography，BACS-MRA）。采用单因素和多因素方法分析两组的基线资料、血管狭窄部位和程度、BAOPS-MRA、BACS-MRA与3个月预后的关系。采用ROC曲线评估BAOPS-MRA预测患者预后的效能，并与BACS-MRA的预测效能进行比较。对BAOPS-MRA、BACS-MRA与发病3个月预后进行相关性分析。 结果 共纳入99例患者，其中预后良好组65例，预后不良组34例。预后良好组的BAOPS-MRA评分为7.0（2.0～16.0）分，预后不良组为2.5（0～12.0）分。多因素分析显示，BAOPS-MRA（OR 1.577，95%CI 1.238～2.008，P=0.001）、BACS-MRA（OR 1.488，95%CI 1.193～1.857，P=0.001）、NIHSS（OR 0.786，95%CI 0.670～0.923，P=0.003）是患者3个月功能预后的独立影响因素。ROC曲线分析显示，BAOPS-MRA评分预测3个月预后的截断值为5分，AUC为0.850（95%CI 0.765～0.936），敏感度为0.794，特异度为0.754；BACS-MRA预测3个月预后的截断值为4分，AUC为0.747（95%CI 0.641～0.852），敏感度为0.765，特异度为0.585，BAOPS-MRA较BACS-MRA的预测效能更佳。BAOPS-MRA（rs=0.580，P＜0.001）、BACS-MRA（rs=0.409，P＜0.001）与患者3个月预后良好呈正相关性。 结论 BAOPS-MRA评分可独立预测非重症基底动脉闭塞患者的3个月功能预后，具有一定的临床推广价值。 Abstract: Objective To evaluate the predictive value of a new basilar artery occlusion prognosis score based on MRA the basilar artery occlusion prognosis score on magnetic resonance angiography (BAOPS-MRA) for the 90-day functional prognosis of patients with non-severe basilar artery occlusion. Methods We proposed the scoring method based on MRA of BAOPS-MRA score. This prospective cohort enrolled the consecutive patients with posterior circulation ischemic stroke diagnosed with basilar artery occlusion and NIHSS ≤15 from January 2019 to December 2020. According to the follow-up results at 3 months of stroke onset, the patients were divided into good prognosis (mRS≤2) group and poor prognosis (mRS >2) group. Based on MRA results at admission, the BAOPS-MRA score, and the basilar artery and collateral circulation score on MRA (BACS-MRA) score were evaluated. Multivariate logistic regression analysis was performed to analyze the relationship between baseline data, BAOPS-MRA, BACS-MRA and 90-day prognosis. The ROC curve was used to evaluate the predictive efficacy of the two scores for 90-day prognosis, and the predictive value of the two scores was compared. Spearman correlation analysis was used to analyze the correlation of BAOPS-MRA and BACS-MRA with 90-day mRS. Results A total of 99 patients were included, including 65 in good prognosis group and 34 in poor prognosis group. The BAOPS-MRA score was 7.0 (2.0-16.0) in good prognosis group and 2.5 (0-12.0) in poor prognosis group. Multivariate analysis showed that BAOPS-MRA (OR 1.577, 95%CI 1.238-2.008, P=0.001), BACS-MRA (OR 1.488, 95%CI 1.193-1.857, P=0.001), NIHSS (OR 0.786, 95%CI 0.670-0.923, P=0.003) were independent predictors of functional outcome at 3 months. ROC curve analysis showed that the cut-off value of BAOPS-MRA score for predicting 90-day prognosis was 5, the area under the curve (AUC) was 0.850 (95%CI 0.765-0.936), the sensitivity was 0.794, and the specificity was 0.754; the cut-off value of BACS-MRA for predicting 90-day prognosis was 4, the AUC was 0.747 (95%CI 0.641-0.852), the sensitivity of 0.765, and the specificity was 0.585. BAOPS-MRA was better than BACS-MRA in predicting 90-day functional prognosis of patients with basilar artery occlusion. BAOPS-MRA (rs=0.580, P

Objective: Endovascular thrombectomy is a long-established therapy for acute basilar artery occlusion (aBAO). Unlike for anterior circulation stroke, cost-effectiveness of endovascular treatment has not been evaluated and is urgently needed to calculate expected health benefits and financial rewards. The aim of this study was therefore to simulate patient-level costs, analyze the economic potential of endovascular thrombectomy in patients with acute basilar artery occlusion (aBAO), and identify major determinants of costeffectiveness. Methods: A Markov model was developed to compare outcome and cost parameters between patients treated by endovascular thrombectomy and patients treated by best medical care, based on four recent prospective clinical trials (ATTENTION, BAOCHE, BASICS, and BEST). Treatment outcomes were derived from the most recent literature. Uncertainty was addressed by deterministic and probabilistic sensitivity analyses. Willingness to pay per QALY thresholds were set at 1x gross domestic product per capita, as recommended by the World Health Organization. Results: Endovascular treatment of acute aBAO stroke yielded an incremental gain of 1.71 quality-adjusted life-years per procedure with an incremental costeffectiveness ratio of $7,596 per QALY. This was substantially lower than the Willingness to pay of $63,593 per QALY. Lifetime costs were most sensitive to costs of the endovascular procedure. Conclusion: Endovascular treatment is cost-effective in patients with aBAO stroke. [ABSTRACT FROM AUTHOR]

This narrative review provides an overview of the posterior circulation and the clinical features of common posterior circulation stroke (PCS) syndromes in the posterior arterial territories and how to distinguish them from mimics. We outline the hyperacute management of patients with suspected PCS with emphasis on how to identify those who are likely to benefit from intervention based on imaging findings. Finally, we review advances in treatment options, including developments in endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT), and the principles of medical management and indications for neurosurgery. Observational and randomised clinical trial data have been equivocal regarding EVT in PCS, but more recent studies strongly support its efficacy. There have been concomitant advances in imaging of posterior stroke to guide optimal patient selection for thrombectomy. Recent evidence suggests that clinicians should have a heightened suspicion of posterior circulation events with the resultant implementation of timely, evidence-based management. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown a potential beneficial effect of endovascular therapy (EVT) in patients with acute basilar artery occlusion (BAO). It was unclear that whether atrial fibrillation (AF) can affect the clinical outcomes for BAO patients treated with EVT. Objectives: To investigate the association between AF and clinical outcomes, and whether AF can modify the efficacy and safety of EVT in patients with BAO. Design: We conducted a multicenter, nationwide, retrospective analysis to investigate how the presence of AF affects treatment allocation for BAO patients. Methods: The endovascular treatment for acute basilar artery occlusion (ATTENTION) registry was a multicenter, prospective study in China that included acute BAO patients who underwent EVT or received best medical management (BMM) between 2017 and 2021. The outcomes include the distribution of 3-month modified Rankin scale (mRS) score, functional independence (defined as mRS 0–3), symptomatic intracerebral hemorrhage, and mortality. Results: 2134 patients were included in the study, of which 619 had AF and 1515 did not have AF. The median age was 65 (interquartile range [IQR]: 56–73) years, and 689 (32.3%) patients were female. Multivariate regression analysis indicated no significant association existed between AF and the distribution of mRS (adjusted common odds ratio, 1.05 [95% CI: 0.88, 1.25]; p = 0.564) at 90 days. Similarly, AF was not found to have a significant association with and other measured outcomes, or with the effects of EVT in AF subgroups for at 90 days as measured by ordinal mRS (p for heterogeneity = 0.247). Finally, no significant differences were found for symptomatic intracerebral hemorrhage and mortality within 90 days between the EVT and BMM groups across AF subgroups. Conclusions: Our results illustrated that the effect of EVT did not differ statistically in acute ischemic stroke patients with and without AF. Moreover, no significant association between AF and functional or safety outcomes could be detected at 90 days. [ABSTRACT FROM AUTHOR]

Background: Recently, the BAOCHE trial and ATTENTION trial registry have demonstrated the efficacy of endovascular treatment (EVT) in patients with acute basilar artery occlusion (BAO), however, the proportion of patients with favorable post-EVT outcomes remains low. The present study aimed to investigate the individual and joint prognostic values of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with acute BAO who have undergone EVT. Methods: We enrolled patients who underwent EVT from the BASILAR registry. Patients were divided into the following groups based on their modified Rankin Scale (mRS) scores at 90 days: favorable-outcome (mRS score: 0–3) and poor-outcome (mRS score: 4–6) groups. Multivariable logistic regression was performed to analyze the association of NLR and PLR with favorable post-EVT outcomes. Results: In total, 585 patients with EVT were recruited. Of these, 189 and 396 patients were in the favorable-outcome and poor-outcome groups, respectively. According to the multivariable logistic regression analyses, both NLR (adjusted odds ratio [aOR], 0.950; 95% confidence interval [CI], 0.920–0.981; P = 0.002) and PLR (aOR, 0.997; 95% CI, 0.995–0.999; P = 0.002) were related to favorable post-EVT outcomes in patients with acute BAO. The optimal cutoff values for the NLR and PLR were 7.75 and 191, respectively. Furthermore, stratified analysis using the multivariable logistic regression model revealed that both NLR and PLR (NLR values ≥ 7.75 and PLR values ≥ 191) were associated with a low rate of favorable outcomes (aOR, 0.292; 95% CI, 0.173–0.494; P < 0.001). Conclusions: Low NLR and PLR were both associated with favorable post-EVT outcomes in patients with acute BAO. Furthermore, the combined value of both inflammatory markers is potentially reliable in predicting clinical post-EVT outcomes. [ABSTRACT FROM AUTHOR]