Endovascular Thrombectomy Shows Durable 3-Year Benefit in Basilar Artery Occlusion
Key Clinical Summary
- Sustained functional benefit: At 3 years, 38.4% of patients treated with endovascular thrombectomy (EVT) achieved functional independence (modified Rankin Scale [MRS] score 0–3) versus 18.3% with medical management alone.
- Lower long-term mortality: EVT was associated with significantly reduced cumulative mortality at 3 years compared with control therapy.
- Age-specific effect: Clinical benefit was observed in patients younger than 70 years, but not in those aged 70 years or older.
Endovascular thrombectomy (EVT) provides durable functional and survival benefits for patients with acute basilar artery occlusion, according to long-term follow-up data from a randomized clinical trial published in JAMA Neurology.
Study Findings
The study represents a 3-year follow-up extension of a multicenter, open-label, assessor-blinded randomized clinical trial conducted at 36 comprehensive stroke centers across China. Between February 2021 and January 2022, 340 adults with imaging-confirmed acute basilar artery occlusion within 12 hours of symptom onset were randomized to EVT plus best medical management or best medical management alone. Follow-up data through January 2025 were available for 307 patients (90.3%).
Among patients with available data, the primary outcome, functional independence defined as a modified Rankin Scale (mRS) score of 0 to 3 at 3 years, was achieved by 78 of 203 patients (38.4%) in the thrombectomy group compared with 19 of 104 patients (18.3%) in the control group. This corresponded to an adjusted risk ratio of 2.05 (95% CI, 1.35–3.11; P = .001). The overall distribution of mRS scores also favored EVT, with an adjusted common odds ratio of 2.60 (95% CI, 1.53–4.43).
Cumulative mortality increased over time in both groups but remained significantly lower among patients treated with EVT. At 3 years, mortality was 55.7% in the thrombectomy group compared with 73.1% in the control group (adjusted risk ratio, 0.76; 95% CI, 0.65–0.89). Prespecified subgroup analyses showed benefit in patients younger than 70 years, while no clear treatment effect was demonstrated in older patients.
Clinical Implications
Basilar artery occlusion is associated with high rates of disability and mortality. While prior trials established the short-term efficacy of EVT, uncertainty remained regarding the durability of benefit. These 3-year data address that gap, demonstrating that early functional gains with thrombectomy persist over time and translate into improved long-term survival.
For clinicians managing acute ischemic stroke, the findings reinforce the importance of rapid diagnosis and timely referral to comprehensive stroke centers capable of performing EVT. The absence of demonstrated benefit in patients aged 70 years or older underscores the need for individualized decision-making, taking into account age, comorbidities, and overall prognosis.
Expert Commentary
“These findings reinforce EVT as the standard of care and support broader implementation and timely access to thrombectomy services for posterior circulation stroke,” wrote Wei Hu, MD, Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China, and study coauthors.
While the researchers emphasize that the trial’s population-based design enhances the generalizability of the findings, they also acknowledge that the exclusion of participants with more severe stroke may limit the applicability of the results to this patient population.
