Journal article
Conventional versus advanced imaging selection for endovascular treatment of basilar artery occlusion strokes
European stroke journal, Vol.11(1), pp.1-10
01/01/2026
DOI: 10.1093/esj/23969873251364973
Abstract
Introduction Endovascular thrombectomy (EVT) is an effective treatment for basilar artery occlusion (BAO) stroke in select patients. While there is a growing body of literature suggesting that advanced imaging modalities such as computed tomography perfusion (CTP) and magnetic resonance (MR) may not be necessary for selecting anterior circulation large vessel occlusion stroke patients for EVT, whether advanced imaging may be superior to conventional imaging (non-contrast CT and CT angiography) in identifying good treatment candidates among BAO patients is less clear. Patients and methods This was a multicenter retrospective cohort study of BAO EVT patients treated from 2013 to 2022 in the Stroke Thrombectomy and Aneurysm Registry. Patients selected for EVT by advanced imaging (CTP or MR) were matched with those selected by conventional imaging using propensity score matching (PSM) accounting for possible confounders. Primary outcome was functional independence at 90 days. Other outcomes include bedridden state or death at 90-days and symptomatic intracranial hemorrhage (sICH). Results 268 patients were included. 150 patients were selected for BAO EVT by conventional imaging, 86 by CTP, and 32 by MR. Patients selected by advanced imaging were significantly older than those selected by conventional imaging (median age 71 vs 64 years, p = 0.001); patient characteristics were otherwise similar between cohorts. After PSM, 90-day outcomes were similar between the two cohorts (p = 0.56), with similar rates of functional independence (39.4% vs 35.1%, p = 0.65), bedridden state or death (40.4% vs 44.7%, p = 0.66), and sICH (3.3% vs 5.7%, p = 0.49) for conventional and advanced imaging groups, respectively. Results were similar across treatment time windows (all p > 0.05). Conclusions Selecting patients for basilar EVT using conventional versus advanced imaging did not result in different clinical outcomes, regardless of treatment time windows. Conventional imaging appears sufficient as a first-line tool for selecting basilar EVT patients in routine clinical practice.
Details
- Title: Subtitle
- Conventional versus advanced imaging selection for endovascular treatment of basilar artery occlusion strokes
- Creators
- Huanwen Chen - National Institute of Neurological Disorders and StrokeMarco Colasurdo - Oregon Health and Science University HospitalHidetoshi Matsukawa - University of South CarolinaConor Cunningham - University of South CarolinaIlko Maier - Universitätsmedizin GöttingenSami Al Kasab - University of South CarolinaPascal Jabbour - Thomas Jefferson UniversityJoon-Tae Kim - Chonnam National University HospitalStacey Quintero Wolfe - New England Baptist HospitalAnsaar Rai - West Virginia UniversityRobert M. Starke - University of MiamiMarios-Nikos Psychogios - University Hospital of BaselEdgar A. Samaniego - Univ Iowa, Iowa City, IA USANitin Goyal - University of Tennessee at KnoxvilleShinichi Yoshimura - Hyogo Medical UniversityHugo Cuellar - Louisiana State University Health Sciences Center ShreveportJonathan A. Grossberg - Emory UniversityAli Alawieh - Emory UniversityAli Alaraj - University of ChicagoMohamad Ezzeldin - University of HoustonDaniele G. Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'AragonaOmar Tanweer - Baylor College of MedicineJustin Mascitelli - The University of Texas Health Science Center at San AntonioIsabel Fragata - Nova InstituteAdam Polifka - University of FloridaFazeel Siddiqui - University of MichiganJoshua Osbun - Washington University in St. LouisRoberto Crosa - Med Uruguaya, Montevideo, UruguayCharles Matouk - University of New HavenMin S. Park - University of VirginiaMichael R. Levitt - University of WashingtonWaleed Brinjikji - Mayo ClinicMark Moss - Washington Regional Medical CenterTravis Dumont - University of ArizonaErgun Daglioglu - Ankara Bilkent City HospitalRichard Williamson - Allegheny General HospitalPedro Navia - Hospital Universitario La PazReade De Leacy - Mount Sinai Health SystemShakeel Chowdhry - NorthShore University HealthSystemDavid J. Altschul - Albert Einstein College of MedicineAlejandro M. Spiotta - University of South CarolinaPeter Kan - The University of Texas Medical Branch at Galveston
- Resource Type
- Journal article
- Publication Details
- European stroke journal, Vol.11(1), pp.1-10
- DOI
- 10.1093/esj/23969873251364973
- ISSN
- 2396-9873
- eISSN
- 2396-9881
- Publisher
- Oxford University Press
- Number of pages
- 10
- Grant note
- Microvention Penumbra RapidAI Stryker Brain Aneurysm Foundation
- Language
- English
- Date published
- 01/01/2026
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9985121482402771
Metrics
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