Background/Aims: Ineffective tissue reperfusion despite successful angiographic reperfusion may contribute to unfavourable outcomes after endovascular therapy (EVT) and might be modulated by intravenous thrombolytic (IVT) before EVT. We compared functional outcomes in patients with basilar artery occlusion (BAO) and successful reperfusion with and without prior IVT.
Methods: Clinical and procedural data of prospectively collected consecutive patients from the multicenter Basilar Artery Treatment and Management (BATMAN) registry between 1/1/2015 and 31/12/2023 were analyzed. EVT patients with successful reperfusion (eTICI 2b-3) were analyzed according to prior IVT using propensity score matching (PSM). Independent ambulation was defined as modified Rankin Scale score (mRS) 0–3; functional independence as mRS 0-2 at 90 days.
Results: Among 361 BAO patients who achieved successful reperfusion after EVT [mean age 68±14; median NIHSS 14 (IQR 7-28)],143 patients were treated with IVT before EVT. In the PSM cohort analysis (139 IVT+EVT vs 138 EVT patients), after logistic regression analysis adjusted for age, NIHSS and time from onset-to-arterial puncture, IVT+EVT was associated with independent ambulation (61.2% vs 45.7%, aOR=1.86, 95%CI 1.07–3.26, p=0.028) and functional independence (52.5% vs 36.2%, aOR=2.01, 95%CI 1.15-3.51, p=0.014) at 90 days compared with EVT alone. Symptomatic intracranial haemorrhage rates were comparable (1.4% vs 0.7%, p=0.761).
Conclusions: In the setting of successful reperfusion by EVT, prior IVT was associated with improved outcomes in BAO patients, without increased bleeding. Randomized trials to assess the safety and efficacy of thrombolytic agents targeting downstream microvascular reperfusion in BAO are warranted.