Aspiration, stent retriever, or combined approach for basilar artery occlusion: a three-way comparative analysis
Author(s)
Type
Journal Article
Abstract
Background and objectives. Basilar artery occlusion (BAO) is a rare but devastating form of ischemic stroke, with high rates of disability and mortality. While randomized trials have demonstrated the benefit of mechanical thrombectomy (MT) in BAO, the optimal first-line technique—aspiration, stent retriever, or a combined approach—remains undefined. This multicenter study aimed to provide a three-way comparison of MT techniques in terms of efficacy, safety, and subgroup-specific outcomes.
Methods and design. We prospectively included 517 consecutive patients with acute isolated BAO treated with MT across seven comprehensive
stroke centers between January 2019 and December 2023. Patients were grouped by first-line technique: aspiration (n=200), stent retriever (n=260), or combined approach (n=57). The primary outcome was favorable functional outcome at 90 days (mRS 0–3). Inverse probability weighting (IPW) adjusted for baseline imbalances. Secondary outcomes included successful recanalization, excellent outcome (mRS 0–1), functional independence (mRS 0–2), mortality, symptomatic intracranial hemorrhage (sICH), and hemorrhagic transformation (HT). Predefined subgroup analyses were
performed.
Results. After adjustment, 90-day outcomes were similar across groups. Stent retrievers achieved higher recanalization rates (RR 1.86 vs aspiration, p<0.001), while the combined technique was associated with less HT (RR 0.39 vs aspiration, p=0.008). In patients ≥80 years, stent
retriever use led to better outcomes than aspiration (39.2% vs 18%; p=0.021). No other significant subgroup interactions were found
Conclusions. While overall functional outcomes were comparable, stent retrievers yielded superior recanalization and the combined technique reduced hemorrhagic complications. Technique selection may benefit from individualized, anatomy-driven decision-making. Randomized studies are warranted.
Methods and design. We prospectively included 517 consecutive patients with acute isolated BAO treated with MT across seven comprehensive
stroke centers between January 2019 and December 2023. Patients were grouped by first-line technique: aspiration (n=200), stent retriever (n=260), or combined approach (n=57). The primary outcome was favorable functional outcome at 90 days (mRS 0–3). Inverse probability weighting (IPW) adjusted for baseline imbalances. Secondary outcomes included successful recanalization, excellent outcome (mRS 0–1), functional independence (mRS 0–2), mortality, symptomatic intracranial hemorrhage (sICH), and hemorrhagic transformation (HT). Predefined subgroup analyses were
performed.
Results. After adjustment, 90-day outcomes were similar across groups. Stent retrievers achieved higher recanalization rates (RR 1.86 vs aspiration, p<0.001), while the combined technique was associated with less HT (RR 0.39 vs aspiration, p=0.008). In patients ≥80 years, stent
retriever use led to better outcomes than aspiration (39.2% vs 18%; p=0.021). No other significant subgroup interactions were found
Conclusions. While overall functional outcomes were comparable, stent retrievers yielded superior recanalization and the combined technique reduced hemorrhagic complications. Technique selection may benefit from individualized, anatomy-driven decision-making. Randomized studies are warranted.
Date Issued
2026-01-01
Date Acceptance
2025-12-03
Citation
Therapeutic Advances in Neurological Disorders, 2026, 19, pp.1-18
ISSN
1756-2856
Publisher
SAGE Publishing
Start Page
1
End Page
18
Journal / Book Title
Therapeutic Advances in Neurological Disorders
Volume
19
Copyright Statement
© The Author(s), 2026. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
License URL
Identifier
10.1177/17562864251410787
Subjects
Plain language summary aspiration
basilar artery occlusion
combined approach
stent retriever
Publication Status
Published
Date Publish Online
2026-01-29