Background Basilar artery occlusions (BAO) account for approximately 1% of all acute ischemic strokes with resultant infarcts of the brainstem, thalamus, and cerebellum. Patients presenting with BAO often experience severe neurologic dysfunction, including advanced motor and bulbar symptoms with rapid decline in levels of consciousness resulting in coma. Mortality rates of 40-80% have been reported. Of individuals surviving the initial ischemic event, 20-40% will progress to good functional outcome. Recent randomized clinical trials (ATTENTION and BAOCHE) have attempted to determine the best treatment methods comparing medical and endovascular therapies. These studies both demonstrated thrombectomy was associated with improved functional status at 90 days as well as increased cerebral hemorrhages. The BAOCHE trial was stopped early due to thrombectomy superiority. Since these studies are limited by exclusive enrollment of Chinese participants, we herein utilize the National Inpatient Sample database (NIS) to elucidate more generalizable outcome differences between patients presenting with BAO treated by endovascular or medical therapies.

Methods Weighted discharge NIS data from 2016-2020 was surveyed for patients admitted with primary International Classification of Disease version 10 (ICD-10) diagnosis of BAO and a reported National Institute of Health Stroke Score (NIHSS). Patients were included if their NIHSS ≥ 10. Due to the non-random nature of the NIS sampling design, we utilized full propensity score matching to adjust confounding for endovascular thrombectomy (EVT) based on age, gender, comorbidities, and NIHSS of the patients. Univariate and multivariate logistic regression was performed, accounting for the sampling design of the NIS, estimating the effect of EVT on rates of favorable functional outcomes, defined as a routine discharge or discharge to a rehabilitation hospital.

Results 5,095 patients met inclusion criteria. 2,545 were managed medically while 2,550 received EVT. After propensity matching, there were no differences in comorbidities or gender. The EVT group was younger (67.7 years vs. 70.2 years, p = 0.005) and presented with higher NIHSS (22.68 vs. 20.84, p < 0.001). Patients treated with EVT had higher absolute, although nonsignificant, rates of favorable functional outcomes compared to those managed medically (12.35% vs. 10.61%, p = 0.687; OR, 1.19 [95% CI, 0.79-1.79]; p = 0.412). There was no difference in the utilization of tPA between those receiving EVT and those who did not (27.45% vs. 23.18%, p = 0.316). There were higher rates of intracerebral hemorrhage (ICH) in the EVT group (16.86% vs. 5.89%, p < 0.001). Subgroup analysis of patients with NIHSS ≥ 20, EVT trends towards higher rates of favorable functional outcomes (10.93% vs. 5.36%, p = 0.06; OR, 2.17 [95% CI, 1.13-4.14]; p = 0.019).

Conclusions In this NIS analysis of patients with BAO presenting with an NIHSS ≥ 20, demonstrates that EVT trends towards, although nonsignificant, rates of favorable functional outcomes.

Disclosures L. Fry: None. A. Alkisawni: None. G. LeBeau: None. C. Heskett: None. F. DeStefano: None. C. Lei: None. K. Le: None. A. Brake: None. J. Peterson: None. A. Rouse: None. K. Ebersole: None.