Early Neurological Deterioration After Thrombectomy in Mild Basilar Artery Occlusion: Insights from a Multicenter Retrospective Study.

RATIONALE AND

OBJECTIVES

Data on early neurological deterioration (END) after endovascular thrombectomy (EVT) in patients with mild basilar artery occlusion (BAO) are scarce.

MATERIALS AND

METHODS

A multicenter retrospective cohort study was conducted including patients with mild BAO (National Institutes of Health Stroke Scale [NIHSS] <10) who underwent EVT between January 2020 and June 2025. END was defined as an increase of ≥4 points in the total NIHSS score within 24 h after EVT. Multivariable logistic regression analyses were performed to assess the association between END and 90-day functional outcomes and to identify factors associated with END.

RESULTS

Among 337 included patients, END occurred in 52 (15.4%), with 78.8% (41/52) of events developing within 12 h after EVT; the median NIHSS increase at END was 9 (interquartile range, 6-13). The presumed mechanisms of END were ischemic progression (n=35), space-occupying edema (n=15), and symptomatic intracranial hemorrhage (n=2). END was independently associated with a lower rate of 90-day functional independence (modified Rankin Scale score ≤2; 32.7% vs 73.0%; adjusted odds ratio [OR], 0.34; 95% confidence interval [CI], 0.17-0.68). Lower baseline NIHSS (adjusted OR per point, 0.74; 95% CI, 0.64-0.85), baseline large cerebellar hemisphere infarction (adjusted OR, 2.18; 95% CI, 1.17-4.61), and successful reperfusion (adjusted OR, 0.44; 95% CI, 0.20-0.89) were independently associated with occurrence of END.

CONCLUSIONS

END occurred in a substantial proportion of EVT-treated patients with mild BAO and was associated with unfavorable outcomes. Several baseline imaging and procedural factors were identified as being associated with an increased risk of END.