Endovascular Treatment of Basilar Artery Occlusion

Acute basilar artery occlusion represents one of the most devastating forms of ischaemic stroke, carrying high rates of mortality and severe disability without prompt intervention. Endovascular treatment has emerged as the primary approach for revascularisation in these patients. Modern practice centres on mechanical thrombectomy using retrievable stent devices or aspiration catheters to restore blood flow with high recanalisation rates. In many centres a combined strategy—mechanical clot removal followed by angioplasty and stenting of underlying atherosclerotic lesions—addresses both thrombotic occlusion and vessel stenosis in a single session. Rapid reperfusion within a critical time window, often guided by advanced imaging of brainstem diffusion changes and collateral circulation, correlates strongly with improved neurological outcome. Procedural refinements such as use of large-bore aspiration catheters, optimisation of first-pass effect, and tailored device selection have further enhanced safety and efficacy. Patient selection criteria now integrate stroke severity scales, vessel imaging scores, and assessment of comorbid conditions, enabling treatment beyond conventional time limits in selected cases. Despite regional variations in procedural protocols, global registry data underscore a consistent association between successful vessel recanalisation, low rates of symptomatic intracranial haemorrhage, and favourable functional recovery at three months.

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Endovascular Treatment of Basilar Artery Occlusion publication trend

The graph below shows the total number of articles in endovascular treatment of basilar artery occlusion across all publications each year (not limited to Nature Index journals).

Technical terms

Basilar artery occlusion: Complete or near-complete blockage of the basilar artery, leading to brainstem ischaemia.

Mechanical thrombectomy: Endovascular removal of an intravascular clot using specialised devices such as retrievable stents or aspiration catheters.

Stent retriever: A self-expanding wire mesh device deployed across a thrombus to engage and extract the clot during thrombectomy.

Angioplasty: Balloon inflation within a narrowed vessel segment to restore luminal diameter, often followed by stent placement.

Recanalization (TICI): Restoration of blood flow graded by the Thrombolysis in Cerebral Infarction scale, with 2b–3 indicating substantial reperfusion.

Modified Rankin Scale (mRS): A clinical scale measuring global disability and functional outcome after stroke, ranging from 0 (no symptoms) to 6 (death).

References

1. Combined Use of Mechanical Thrombectomy with Angioplasty and Stenting for Acute Basilar Occlusions with Underlying Severe Intracranial Vertebrobasilar Stenosis: Preliminary Experience from a Single Chinese Center. American Journal of Neuroradiology (2015).
2. Evaluation of Endovascular Treatment for Acute Basilar Occlusion in a State-Wide Prospective Stroke Registry. Frontiers in Neurology (2021).
3. Posterior Circulation Endovascular Thrombectomy for Large-Vessel Occlusion: Predictors of Favorable Clinical Outcome and Analysis of First-Pass Effect. American Journal of Neuroradiology (2021).
4. Predictors of Outcome After Endovascular Thrombectomy in Acute Basilar Artery Occlusion and the 6hr Time Window to Recanalization. Frontiers in Neurology (2019).
5. Diffusion-Weighted Imaging Score of the Brain Stem: A Predictor of Outcome in Acute Basilar Artery Occlusion Treated with the Solitaire FR Device. American Journal of Neuroradiology (2014).