Thrombectomy Alone or Alongside Intravenous Thrombolysis in Managing Acute Ischemic Stroke Caused by Basilar Artery Occlusion: A Multicenter Observational Study

BACKGROUND AND PURPOSE: It remains unclear whether the combination of endovascular treatment (EVT) with intravenous thrombolysis (IVT) results in a more favorable functional outcome than EVT alone in managing cases of acute ischemic stroke (AIS) caused by basilar artery occlusion (BAO). Thus, this study aimed to compare the outcomes of 2 approaches—direct endovascular treatment (DEVT) and bridging therapy (IVT plus EVT)—in patients with acute BAO presenting within 4.5 hours of stroke onset.

MATERIALS AND METHODS: This multicenter retrospective cohort study included 153 patients with acute BAO presenting within 4.5 hours of stroke onset. Of these patients, 65 (42.5%) and 88 (57.5%) underwent DEVT and bridging therapy, respectively. The primary outcome was defined as good functional outcome (mRS, 0–3) at 90 days. Additionally, preoperative clinical features, thrombectomy attempts, successful reperfusion rates, incidences of symptomatic intracranial hemorrhage (sICH), and mortality were compared between the 2 groups.

RESULTS: At 90 days, the rate of good functional outcome was comparable between the DEVT (44.6%) and bridging-therapy (39.8%) groups (adjusted odds ratio [aOR], 1.12; 95% CI, 0.55–2.31; P = .753). The bridging-therapy group exhibited a lower percentage of patients requiring ≥3 attempts of stent retrieval (aOR, 0.39; 95% CI, 0.16–0.93; P = .034). Preoperative clinical features, rate of successful reperfusion, sICH, and mortality were similar between the 2 groups.

CONCLUSIONS: In patients with BAO-induced AIS, DEVT demonstrates a comparable functional outcome to bridging therapy within 4.5 hours of symptom onset, but IVT reduces the number of thrombectomy attempts.