Abstract:

Objective

To investigate the safety and efficacy of direct thrombectomy versus bridging therapy for patients with acute ischemic stroke caused by arteriosclerotic basilar artery occlusion （BAO）within the intravenous thrombolysis time window.

Methods

This study conducted a retrospective analysis of clinical data from patients with arteriosclerotic basilar artery occlusion （BAO）， who initiated treatment within 4.5 hours of symptom onset， from January 2018 to October 2023， across four stroke centers.The primary evaluation metrics included the rate of favorable prognosis at 90 days， as well as preoperative clinical characteristics， number of thrombectomy attempts， successful reperfusion rates， incidence of symptomatic intracranial hemorrhage， and mortality rates among both patient groups.Efficacy of the two treatment modalities was compared using multivariate logistic regression analysis.

Results

A total of 63 BAO patients were included in the study， with 25 undergoing direct mechanical thrombectomy and 38 receiving bridging therapy.There were no statistically significant differences in preoperative baseline data between the two groups.In terms of the adjusted 90-day good prognosis rate and functional independence rate， the bridging therapy group outperformed the direct thrombectomy group （P=0.026 and P=0.011）， and also required fewer thrombectomy attempts （P=0.032）.No significant differences were observed between the two groups in terms of successful reperfusion rates， incidence of symptomatic intracranial hemorrhage， and mortality rates（P＞0.05）.

Conclusion

For arteriosclerotic BAO patients treated within 4.5 hours， bridging therapy provides a better prognosis compared to direct mechanical thrombectomy， with fewer thrombectomy attempts required.

Key words: Intracranial atherosclerosis, Basilar artery occlusion, Stroke, Thrombectomy, Bridging therapy