Objective:

To identify predictors of good functional outcome and the need for adjunctive stenting or angioplasty after basilar artery occlusion (BAO). 

Background:

Posterior circulation strokes account for nearly 20% of ischemic strokes and are a major cause of long-term disability and death. Randomized trials have shown benefit of endovascular therapy (EVT) in these patients with NIHSS ≥10 within 24 hours. Despite high reperfusion rates, adjunctive stenting or angioplasty is often needed.

Design/Methods:

We retrospectively analyzed consecutive patients undergoing EVT for BAO at a Stroke Belt tertiary stroke center between January 2021 and June 2025. We collected demographics, vascular risk factors, NIHSS, stroke mechanism, and procedural details. Primary outcomes were favorable functional outcome (90 day mRS 0–3) and need for adjunctive intervention such as stenting and angioplasty. Secondary outcomes included post-procedure ICH and good disposition (home or inpatient rehabilitation). Multivariate logistic regression identified independent predictors of favorable functional outcome and adjunctive intervention.

Results:

Sixty-four patients underwent BAO EVT (median 62.5 years, 34% female, median NIHSS 17). Favorable outcomes were associated with younger age, lower admission NIHSS, and IV thrombolytic use.  No patients with incomplete reperfusion (TICI ≤2a) achieved mRS 0–3.  Adjunctive interventions were employed in 20% of EVT cases (9 stenting, 10 angioplasty, 6 with both), more often in proximal or middle BAO. These patients were numerically younger and male (non-significant) but without significant association to stroke mechanism, disposition, or functional outcome. Rates of post-procedure ICH were similar regardless of adjunctive therapy.

Conclusions:

Baseline severity and reperfusion success critically determine functional outcomes for BAO while predictors of need for adjunctive stenting or angioplasty remain unclear. Our sample had lower rates of intracranial atherosclerosis, higher adjunctive therapy use, and worse outcomes than trial populations, emphasizing real-world heterogeneity. Further study is warranted to clarify the role of angioplasty and stenting following EVT in BAO.