Late Endovascular Thrombectomy Effective in Vertebrobasilar Artery Occlusion

A multicenter, prospective Chinese cohort study suggested that endovascular thrombectomy (EVT) plus best medical treatment (BMT) improved functional outcomes and survival in patients with vertebrobasilar artery occlusion treated beyond 24 hours after last known well time. Conducted between 2019 and 2024 across 11 comprehensive stroke centers in China, the study included 202 patients (median age 64 years, 78.2% male), equally divided between the EVT plus BMT and BMT-only groups. Patients had a median posterior circulation Acute Stroke Prognosis Early Computed Tomography Score of 8 and a median onset-to-admission time of 48 hours. The primary outcome was good functional status at 90 days, defined as a modified Rankin Scale score of 0-3. Using propensity score matching, patients treated with EVT plus BMT had a significantly higher rate of good functional outcomes compared to those receiving BMT alone (57.7% vs 45.1%; adjusted risk ratio [aRR], 1.35). Mortality was also lower in the EVT plus BMT group (12.7% vs 28.2%; aRR, 0.27). The symptomatic intracranial hemorrhage was numerically higher but not statistically significant (5.6% vs 0%; P = .13). Similar findings were observed using inverse probability of treatment weighting analysis (aRR, 1.33). These results suggest that EVT plus BMT may improve functional outcomes and reduce mortality in patients with vertebrobasilar artery occlusion beyond 24 hours, supporting the need for randomized clinical trials in this population. The effectiveness of EVT for patients with vertebrobasilar artery occlusion who underwent EVT within 24 hours of symptom onset was established. Source: https://jamanetwork.com/