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- The landscape of acute ischemic stroke treatment changed dramatically with endovascular thrombectomy (EVT).
- However, few patients with basilar artery occlusions were included in major EVT trials.
- Basilar artery occlusion accounts for 10% of large vessel occlusions and can result in devastating neurological deficits.
- The recently published BASICS trial evaluated the efficacy of EVT within 6 hours of symptom onset in 300 patients with basilar artery occlusion strokes.
- 44.2% of the EVT group had a good outcome compared to 37.7% of the medical treatment group (p=0.19).
- Good outcome was defined as modified Rankin scale of 0 (no symptoms) to 3 (moderate disability but able to walk without assistance) at 90 days.
- Symptomatic intracranial hemorrhage was higher in the EVT group (4.5% vs. 0.7%, p=0.06).
- History of AFib was more common in the EVT group (28.6% vs. 15.1%).
- It is important to note that this study did not use advanced neuroimaging for patient selection unlike in landmark EVT trials of anterior circulation large vessel occlusion strokes.
Bottom Line: There is no significant difference between endovascular thrombectomy and medical management for basilar artery occlusion strokes within 6 hours of symptom onset.
References
Langezaal LCM, van der Hoeven EJRJ, Mont’Alverne FJA, et al. Endovascular therapy for stroke due to basilar-artery occlusion. N Engl J Med. 2021;384(20):1910-20.
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