The following is a summary of “IV Thrombolysis in Basilar Artery Occlusion Outcomes and Comparison With Endovascular Thrombectomy,” published in the March 2024 issue of Neurology by Räty et al.
Intravenous thrombolysis (IVT) was previously studied for basilar artery occlusion (BAO) but was underrepresented in recent trials focused on recanalization therapy.
Researchers conducted a retrospective study to compare outcomes in BAO patients treated with IVT alone to those who received endovascular thrombectomy (EVT).
They involved consecutive patients with BAO who received either IVT or EVT within 48 hours of symptom onset. The primary outcome, gathered via phone by a stroke physician, was a favorable functional outcome (defined as a modified Rankin Scale 0–3) at 3 months. Initially, outcomes and factors were analyzed in the IVT-only cohort (1995–2022). Subsequently (2010–2022), they compared functional outcomes between IVT alone versus EVT ± IVT.
The results showed that of the 376 patients with acute BAO who underwent recanalization therapy, 65.2% received only IVT. Among the IVT-only cohort, the median NIH Stroke Scale was 18, and half experienced onset-to-treatment times exceeding 6 hours. 46.5% of IVT-treated patients achieved a favorable functional outcome at 3 months, with a mortality rate of 35.9% and 11.1% experiencing symptomatic intracranial hemorrhage (sICH). Factors predicting favorable outcomes included younger age, less severe symptoms, and fewer baseline ischemic changes. In the 2010–2022 cohort, compared to EVT+/-IVT patients (n = 121), the IVT-only group (n = 122) had higher odds of favorable functional outcome (IVT 58.2% vs. EVT 43.0%, adjusted OR 2.82 [95% CI 1.31–6.05]).
Investigators concluded IVT alone was comparable to recent trials and superior to EVT±IVT in their study, suggesting its potential as first-line BAO therapy beyond standard windows.