Document Type
Article
Publication Date
1-1-2026
Abstract
INTRODUCTION: Endovascular thrombectomy (EVT) is an effective treatment for basilar artery occlusion (BAO) stroke in select patients. While there is a growing body of literature suggesting that advanced imaging modalities such as computed tomography perfusion (CTP) and magnetic resonance (MR) may not be necessary for selecting anterior circulation large vessel occlusion stroke patients for EVT, whether advanced imaging may be superior to conventional imaging (non-contrast CT and CT angiography) in identifying good treatment candidates among BAO patients is less clear.
PATIENTS AND METHODS: This was a multicenter retrospective cohort study of BAO EVT patients treated from 2013 to 2022 in the Stroke Thrombectomy and Aneurysm Registry. Patients selected for EVT by advanced imaging (CTP or MR) were matched with those selected by conventional imaging using propensity score matching (PSM) accounting for possible confounders. Primary outcome was functional independence at 90 days. Other outcomes include bedridden state or death at 90-days and symptomatic intracranial hemorrhage (sICH).
RESULTS: 268 patients were included. 150 patients were selected for BAO EVT by conventional imaging, 86 by CTP, and 32 by MR. Patients selected by advanced imaging were significantly older than those selected by conventional imaging (median age 71 vs 64 years, p = 0.001); patient characteristics were otherwise similar between cohorts. After PSM, 90-day outcomes were similar between the two cohorts (p = 0.56), with similar rates of functional independence (39.4% vs 35.1%, p = 0.65), bedridden state or death (40.4% vs 44.7%, p = 0.66), and sICH (3.3% vs 5.7%, p = 0.49) for conventional and advanced imaging groups, respectively. Results were similar across treatment time windows (all p > 0.05).
CONCLUSIONS: Selecting patients for basilar EVT using conventional versus advanced imaging did not result in different clinical outcomes, regardless of treatment time windows. Conventional imaging appears sufficient as a first-line tool for selecting basilar EVT patients in routine clinical practice.
Recommended Citation
Chen, Huanwen; Colasurdo, Marco; Matsukawa, Hidetoshi; Cunningham, Conor; Maier, Ilko; Al Kasab, Sami; Jabbour, Pascal; Kim, Joon-Tae; Wolfe, Stacey Quintero; Rai, Ansaar; Starke, Robert M.; Psychogios, Marios-Nikos; Samaniego, Edgar A.; Goyal, Nitin; Yoshimura, Shinichi; Cuellar, Hugo; Grossberg, Jonathan A.; Alawieh, Ali; Alaraj, Ali; Ezzeldin, Mohamad; Romano, Daniele G.; Tanweer, Omar; Mascitelli, Justin; Fragata, Isabel; Polifka, Adam; Siddiqui, Fazeel; Osbun, Joshua; Crosa, Roberto; Matouk, Charles; Park, Min S.; Levitt, Michael R.; Brinjikji, Waleed; Moss, Mark; Dumont, Travis; Daglioglu, Ergun; Williamson, Richard; Navia, Pedro; De Leacy, Reade; Chowdhry, Shakeel; Altschul, David J.; Spiotta, Alejandro M.; and Kan, Peter, "Conventional Versus Advanced Imaging Selection for Endovascular Treatment of Basilar Artery Occlusion Strokes." (2026). Department of Medicine Faculty Papers. Paper 545.
https://jdc.jefferson.edu/medfp/545
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License
PubMed ID
41614473
Language
English
Comments
This article is the author's final published version in European Stroke Journal, Volume 11, Issue 1, January 2026, Pages 1-10.
The published version is available at https://doi.org/10.1093/esj/23969873251364973. Copyright © The Author(s). Published by Oxford University Press on behalf of the European Stroke Organisation 2026.