PLoS One. 2026 Jul 14;21(7):e0353204. doi: 10.1371/journal.pone.0353204. eCollection 2026.
ABSTRACT
BACKGROUND: Basilar artery occlusion (BAO) is a severe form of ischemic stroke associated with high morbidity and mortality. Whether BAO patients derive similar benefits from CT perfusion (CTP)-guided endovascular treatment (EVT) as those with anterior circulation stroke (ACS) remains unclear.
AIM: This study aimed to compare the efficacy and safety of EVT based on computed tomography (CT) perfusion between patients with BAO and those with ACS.
METHODS: This analysis was conducted using data from a prospective multicenter Registry on International Stroke Perfusion Imaging. A total of 256 patients with 36 BAO and 220 ACS who received CTP-guided EVT were included. Propensity score matching (PSM) in a 1:2 ratio was performed to adjust for baseline imbalances. Multivariate logistic regression was used to identify independent predictors of mRS 3-6 at 90 days as poor functional outcome and mortality.
RESULTS: Prior to matching, BAO patients had higher baseline NIHSS scores (24.0 ± 9.8 vs. 15.2 ± 6.4, p < 0.001), smaller ischemic core volumes (8.7 ± 11.4 mL vs. 33.2 ± 38.9 mL, p < 0.001), and higher mismatch ratios (0.9 ± 0.1 vs. 0.7 ± 0.2, p < 0.001) than ACS patients. After matching, BAO patients had significantly shorter door-to-reperfusion time (3.2 ± 1.1 vs. 4.3 ± 2.9 hours, p = 0.007) and lower rates of hemorrhagic transformation (19.4% vs. 48.6%, p = 0.006). Multivariate analysis identified baseline NIHSS score (OR = 1.052, 95% CI: 1.013-1.092, p = 0.009) and ASPECT score (OR = 0.813, 95% CI: 0.682-0.969, p = 0.021) as independent predictors of poor outcome, while age (OR = 1.037, 95%CI: 1.006-1.069, p = 0.020) and baseline NIHSS score (OR = 1.070, 95% CI: 1.024-1.119, p = 0.002) were independent predictors of mortality. No significant differences were observed in 90-day functional independence (mRS 0-2) or mortality between BAO group and ACS group.
CONCLUSIONS: Despite presenting with more severe neurological deficits, BAO patients treated with CTP-guided EVT achieved comparable functional outcomes and mortality to ACS patients, with shorter reperfusion times and fewer hemorrhagic complications. CTP-based selection may facilitate effective EVT in BAO.
PMID:42447105 | DOI:10.1371/journal.pone.0353204