Acute basilar artery occlusion (BAO) is a rare large-vessel occlusion associated with high morbidity and mortality. Modern thrombectomy with stent retrievers and large-bore aspiration catheters is highly effective in achieving recanalization, but a direct comparison of different techniques for acute BAO has not been performed. Therefore, the authors sought to compare the technical effectiveness and clinical outcomes of stent retriever–assisted aspiration (SRA), aspiration alone (AA), and a stent retriever with or without manual aspiration (SR) for treatment of patients presenting with acute BAO and to evaluate predictors of clinical outcome in their cohort.

A retrospective analysis of databases of large-vessel occlusion treated with endovascular intervention at two US endovascular neurosurgery centers was conducted. Patients ≥ 18 years of age with acute BAO treated between January 2013 and December 2020 with stent retrievers or large-bore aspiration catheters were included in the study. Demographic information, procedural details, angiographic results, and clinical outcomes were extracted for analysis.

Eighty-three patients (median age 67 years [IQR 58–76 years]) were included in the study; 33 patients (39.8%) were female. The median admission National Institutes of Health Stroke Scale (NIHSS) score was 16 (IQR 10–21). Intravenous alteplase was administered to 26 patients (31.3%). The median time from symptom onset to groin or wrist puncture was 256 minutes (IQR 157.5–363.0 minutes). Overall, successful recanalization was achieved in 74 patients (89.2%). The SRA technique had a significantly higher rate of modified first-pass effect (mFPE; 55% vs 31.8%, p = 0.032) but not true first-pass effect (FPE; 45% vs 34.9%, p = 0.346) than non-SRA techniques. Good outcome (modified Rankin Scale [mRS] score 0–2) was not significantly different among the three techniques. Poor outcome (mRS score 3–6) was associated with a higher median admission NIHSS score (12.5 vs 19, p = 0.007), a higher rate of adjunctive therapy usage (9% vs 0%, p < 0.001), and a higher rate of intraprocedural complications (10.7% vs 14.5%, p = 0.006). The admission NIHSS score significantly predicted good outcome (OR 0.98, 95% CI 0.97–0.099; p = 0.032). Incomplete recanalization after thrombectomy significantly predicted mortality (OR 1.68, 95% CI 1.18–2.39; p = 0.005).

The evaluated techniques resulted in high recanalization rates. The SRA technique was associated with a higher rate of mFPE than AA and SR, but the clinical outcomes were similar. A lower admission NIHSS score predicted a better prognosis for patients, whereas incomplete recanalization after thrombectomy predicted mortality.

急性基底动脉闭塞（BAO）是一种罕见的大血管闭塞，发病率和死亡率高。带有支架取栓器和大口径抽吸导管的现代血栓切除术在实现再通方面非常有效，但尚未对急性 BAO 的不同技术进行直接比较。因此，作者试图比较支架取栓器辅助抽吸 (SRA)、单独抽吸 (AA) 和带或不带手动抽吸 (SR) 的支架取栓器治疗急性 BAO 和评估其队列中临床结果的预测因子。

对美国两个血管内神经外科中心接受血管内介入治疗的大血管闭塞数据库进行了回顾性分析。研究包括在 2013 年 1 月至 2020 年 12 月期间接受支架取栓器或大口径抽吸导管治疗的 18 岁以上急性 BAO 患者。提取人口统计学信息、手术细节、血管造影结果和临床结果进行分析。

83 名患者（中位年龄 67 岁 [IQR 58-76 岁]）被纳入研究；33 名患者 (39.8%) 为女性。美国国立卫生研究院卒中量表 (NIHSS) 的平均入院分数为 16 (IQR 10-21)。26 名患者（31.3%）接受了静脉阿替普酶治疗。从症状出现到腹股沟或手腕穿刺的中位时间为 256 分钟（IQR 157.5-363.0 分钟）。总体而言，74 名患者 (89.2%) 实现了成功的再通。SRA 技术具有显着更高的改良首过效应率（mFPE；55% 对 31.8%，p = 0.032），但不是真正的首过效应（FPE；45% 对 34.9%，p = 0.346）。 SRA 技术。三种技术的良好结果（改良 Rankin 量表 [mRS] 评分 0-2）没有显着差异。结果不佳（mRS 评分 3-6）与较高的入院 NIHSS 评分中位数（12.5 对 19，p = 0.007）、辅助治疗使用率较高（9% 对 0%，p < 0.001）和更高术中并发症发生率（10.7% 对 14.5%，p = 0.006）。入院 NIHSS 评分显着预测了良好的结果（OR 0.98，95% CI 0.97–0.099；p = 0.032）。血栓切除术后不完全再通显着预测死亡率（OR 1.68，95% CI 1.18–2.39；p = 0.005）。18–2.39；p = 0.005）。18–2.39；p = 0.005）。

评估的技术导致高再通率。与 AA 和 SR 相比，SRA 技术与更高的 mFPE 发生率相关，但临床结果相似。较低的入院 NIHSS 评分预测患者的预后较好，而血栓切除术后不完全再通可预测死亡率。