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Thrombectomy alone versus intravenous thrombolysis before thrombectomy for acute basilar artery occlusion
  1. Meng Guo1,2,
  2. Chengsong Yue2,
  3. Jie Yang2,
  4. Jinrong Hu2,
  5. Changwei Guo2,3,
  6. Zhouzhou Peng2,
  7. Rui Xu2,
  8. Dahong Yang2,
  9. Weilin Kong2,
  10. Xiang Liu2,
  11. Jiacheng Huang2,
  12. Yan Tian2,
  13. Fengli Li2,
  14. Chang-Qing Li1,2
  1. 1Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing, China
  2. 2Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
  3. 3Department of Neurology, Guangyang Bay Laboratory, Chongqing, Chongqing, China
  1. Correspondence to Professor Chang-Qing Li, Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan, 400016, China; licq{at}; Dr Fengli Li, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China; lifengli01{at}


Background Endovascular treatment (EVT) is a well-established approach for acute ischemic stroke. Whether bridging intravenous thrombolysis (IVT) before EVT confers any benefits remains uncertain. The objective of the study was to compare the efficacy and safety of direct EVT with or without bridging IVT in patients with acute basilar artery occlusion (BAO).

Methods This multicenter cohort study enrolled 647 patients with acute BAO who underwent either bridging IVT before EVT or direct EVT from the BASILAR registry. The primary outcome was an independent functional outcome measured by the modified Rankin Scale (mRS) score of 0–2. Secondary outcomes included excellent functional outcome (mRS 0–1), favorable functional outcome (mRS 0–3), and mortality rate at 90 days, as well as symptomatic intracranial hemorrhage (sICH), and successful reperfusion between the two treatment groups.

Results Direct EVT and bridging IVT before EVT exhibited similar primary outcomes (27.3% vs 27.7%, respectively) and distributions of mRS scores at 90 days. Moreover, rates of sICH and 90-day mortality were not significantly different between the two groups (7.3% vs 6.0%, adjusted OR (aOR) 0.79, 95% CI 0.34 to 1.86, P=0.84 for sICH; 46.8% vs 43.7%, aOR 0.86, 95% CI 0.54 to 1.38, P=0.53 for mortality).

Conclusions Among patients with acute BAO, functional outcomes were similar between those treated with bridging IVT before EVT and those treated with direct EVT, and there was no difference between the two groups in terms of sICH and mortality rates.

  • Thrombectomy
  • Thrombolysis
  • Intervention
  • Stroke

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • MG and CY contributed equally.

  • Contributors CQ-L, FL-L, MG and CY were responsible for the study design, literature research, data acquisition, statistical analysis and manuscript drafting. MG and CY was responsible for the manuscript editing and the data. CL and FL were responsible for guaranteeing the integrity of the entire study, study design. JY, JH and CG were responsible for literature research, statistical analysis. ZP, RX, DY, WK, XL and YT pwere responsible for data acquisition. JH made a critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.