Endovascular Therapy for Stroke Due to Basilar-Artery Occlusion

This randomized multicenter trial (BASICS) assessed the efficacy of endovascular therapy versus standard medical management in patients with acute basilar-artery occlusion. Three hundred patients were randomized within 6 hours of estimated stroke onset, with most receiving intravenous thrombolysis (approximately 79%). Endovascular therapy was initiated at a median of 4.4 hours. A favorable functional outcome at 90 days (modified Rankin score 0–3) occurred in 44.2% of patients receiving endovascular therapy and 37.7% in the medical care group (risk ratio 1.18; 95% CI, 0.92–1.50). Mortality rates were 38.3% and 43.2%, respectively, while symptomatic intracranial hemorrhage was more frequent after intervention (4.5% vs. 0.7%). The trial did not show a statistically significant benefit, but confidence intervals suggest the possibility of substantial therapeutic benefit. The authors note challenges in trial recruitment and crossover, limiting power. They emphasize the need for additional, larger studies to determine efficacy and optimize patient selection criteria in basilar-artery occlusion.

This randomized multicenter trial (BASICS) assessed the efficacy of endovascular therapy versus standard medical management in patients with acute basilar-artery occlusion. Three hundred patients were randomized within 6 hours of estimated stroke onset, with most receiving intravenous thrombolysis (approximately 79%). Endovascular therapy was initiated at a median of 4.4 hours. A favorable functional outcome at 90 days (modified Rankin score 0–3) occurred in 44.2% of patients receiving endovascular therapy and 37.7% in the medical care group (risk ratio 1.18; 95% CI, 0.92–1.50). Mortality rates were 38.3% and 43.2%, respectively, while symptomatic intracranial hemorrhage was more frequent after intervention (4.5% vs. 0.7%). The trial did not show a statistically significant benefit, but confidence intervals suggest the possibility of substantial therapeutic benefit. The authors note challenges in trial recruitment and crossover, limiting power. They emphasize the need for additional, larger studies to determine efficacy and optimize patient selection criteria in basilar-artery occlusion.