Intravenous thrombolysis versus endovascular thrombectomy in acute basilar artery occlusion—A multicenter cohort study Article Swipe
Silja Räty
,
Davide Strambo
,
Alexandra Gómez-Expósito
,
João Pedro Marto
,
João Nuno Ramos
,
Stefan Krebs
,
Pekka Virtanen
,
Juhani Ritvonen
,
Mohamad Abdalkader
,
Piers Klein
,
Tiina Sairanen
,
M. Sýkora
,
Perttu J. Lindsberg
,
Sven Poli
,
Patrik Michel
,
Thanh N. Nguyen
,
Daniel Strbian
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1177/17474930251344451
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1177/17474930251344451
Background: Randomized controlled trials have demonstrated an improved outcome of basilar artery occlusion (BAO) with endovascular thrombectomy (EVT) compared to best medical treatment. However, a minority of the patients recruited up to 12–24 h from onset in the positive trials received intravenous thrombolysis (IVT), and a trial with a higher IVT rate did not show superiority of EVT. Thus, the efficacy and safety of EVT compared to IVT for BAO remain less clear. Aims: We aimed to compare outcomes after IVT alone to EVT with or without IVT for acute BAO. Methods: This international, observational, retrospective study included patients who received recanalization therapy for BAO at six centers between January 2010 and March 2024. The primary outcome was 3-month modified Rankin Scale (mRS) score 0–3, and secondary outcomes comprised mRS 0–2, ordinal mRS, mortality, and symptomatic intracranial hemorrhage. Outcomes after IVT versus EVT ± IVT were compared using inverse probability-weighted regression adjustment models adjusting for known predictors of outcome in BAO and baseline variables differing between the treatment groups. Interaction of the treatment group with symptom severity and onset-to-treatment time was tested. Results: Of 523 patients with BAO (median age 69, 35.2% women), 28.9% received IVT and 71.1% EVT ± IVT. The IVT-alone group had a lower baseline National Institutes of Health Stroke Scale score (median 11 vs 15) but equally extensive ischemic changes in baseline imaging. After inverse probability-weighted regression adjustment, the IVT-alone group had higher odds of mRS 0–3 (adjusted odds ratio (aOR) = 2.33 [95% confidence interval (CI) = 1.31–4.12]), mRS 0–2 (aOR = 1.93 [95% CI = 1.12–3.30]), lower median mRS (aOR = 1.81 [95% CI = 1.21–2.71]), and lower mortality (aOR = 0.53 [95% CI = 0.29–0.97]), but no difference in symptomatic intracranial hemorrhage (aOR = 0.81 [95% CI = 0.28–2.36]). No interactions for the primary outcome were found. Conclusion: In this study, patients with BAO had better outcome after IVT than EVT ± IVT independent of symptom severity and time from onset. Although the non-randomized design of the study warrants caution, the results encourage further trials comparing EVT and IVT to guide recanalization therapy in BAO patients. Data access statement: Anonymized data are available upon reasonable request to the corresponding author following the national legislation.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1177/17474930251344451
- OA Status
- hybrid
- Cited By
- 1
- References
- 33
- Related Works
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- OpenAlex ID
- https://openalex.org/W4410348275
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4410348275Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1177/17474930251344451Digital Object Identifier
- Title
-
Intravenous thrombolysis versus endovascular thrombectomy in acute basilar artery occlusion—A multicenter cohort studyWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
-
2025Year of publication
- Publication date
-
2025-06-13Full publication date if available
- Authors
-
Silja Räty, Davide Strambo, Alexandra Gómez-Expósito, João Pedro Marto, João Nuno Ramos, Stefan Krebs, Pekka Virtanen, Juhani Ritvonen, Mohamad Abdalkader, Piers Klein, Tiina Sairanen, M. Sýkora, Perttu J. Lindsberg, Sven Poli, Patrik Michel, Thanh N. Nguyen, Daniel StrbianList of authors in order
- Landing page
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https://doi.org/10.1177/17474930251344451Publisher landing page
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YesWhether a free full text is available
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hybridOpen access status per OpenAlex
- OA URL
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https://doi.org/10.1177/17474930251344451Direct OA link when available
- Concepts
-
Medicine, Thrombolysis, Basilar artery, Endovascular treatment, Occlusion, Cohort, Stroke (engine), Acute stroke, Cohort study, Radiology, Cardiology, Internal medicine, Tissue plasminogen activator, Myocardial infarction, Aneurysm, Mechanical engineering, EngineeringTop concepts (fields/topics) attached by OpenAlex
- Cited by
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1Total citation count in OpenAlex
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2025: 1Per-year citation counts (last 5 years)
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33Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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