Impact of the basilar artery occlusion location on the recanalization rate and clinical outcome with endovascular therapy

Abstract Patients with basilar artery occlusion (BAO) stroke tend to have poor prognoses. This study aimed to explore the impact of the BAO location on the recanalization rate and clinical outcome after endovascular therapy (EVT). Patients with acute BAO who underwent EVT between March 2014 and October 2022 at four centers were included in this study. The BAO sites were classified as proximal, middle, and distal according to the angiographic findings. The favorable outcome measures for this study were successful recanalization, defined as modified thrombolysis in cerebral infarction score of 2b to 3, and a 90-day modified Rankin Scale (mRS) of 0 to 3. The association between the BAO location and clinical outcome following EVT was assessed. A total of 235 patients with BAO were analyzed, of whom 55 (22.3%) had proximal occlusion, 75 (30.4%) had middle occlusion, and 117 (47.4%) had distal occlusion. The rates of successful recanalization, first-pass recanalization, and favorable clinical outcome were significantly higher in the distal group than those in the proximal and middle groups (all P < 0.05). The multivariate-adjusted model showed that the BAO location did not impact clinical outcome ( P = 0.249). However, the sensitivity analysis identified the distal BAO location as a predictor of favorable clinical outcome in patients with successful recanalization (adjusted odds ratio, 0.43; 95% confidence interval, 0.25–0.73; P = 0.002). The recanalization rate and clinical outcome for BAO after EVT differs according to the specific location. Distal BAO was associated with favorable clinical outcome after successful recanalization.