Endovascular Therapy for Basilar-Artery Occlusion — Still Waiting for Answers

This editorial reviews findings from the BASICS and BEST trials, which evaluated endovascular therapy for acute basilar-artery occlusion. Unlike proven benefit in anterior-circulation large-vessel strokes, these trials failed to show significant improvement in functional outcomes with endovascular therapy compared to standard care. In BASICS, 44.2% of patients in the endovascular group versus 37.7% in the medical group achieved a modified Rankin score of 0–3 at 90 days—non-significant. Similarly, the BEST trial showed 42% versus 32%. Trial limitations included lack of advanced imaging for ischemic injury or thrombus burden and substantial non-enrollment of eligible patients who received endovascular therapy outside the study. The editorial critiques use of the modified Rankin scale for posterior strokes and calls for more sensitive outcome metrics and better patient selection using imaging. It concludes that endovascular therapy for basilar-artery occlusion remains of unproven value and merits further trials with refined methodology.

This editorial reviews findings from the BASICS and BEST trials, which evaluated endovascular therapy for acute basilar-artery occlusion. Unlike proven benefit in anterior-circulation large-vessel strokes, these trials failed to show significant improvement in functional outcomes with endovascular therapy compared to standard care. In BASICS, 44.2% of patients in the endovascular group versus 37.7% in the medical group achieved a modified Rankin score of 0–3 at 90 days—non-significant. Similarly, the BEST trial showed 42% versus 32%. Trial limitations included lack of advanced imaging for ischemic injury or thrombus burden and substantial non-enrollment of eligible patients who received endovascular therapy outside the study. The editorial critiques use of the modified Rankin scale for posterior strokes and calls for more sensitive outcome metrics and better patient selection using imaging. It concludes that endovascular therapy for basilar-artery occlusion remains of unproven value and merits further trials with refined methodology.