Introduction: Intracranial atherosclerotic disease (ICAD) has been identified as a major cause of acute basilar artery occlusion (BAO).This study compared the characteristics and treatment outcomes in acute BAO patients with and without ICAD. Methods: A prospective cohort study was conducted at 115 People’s Hospital, Ho Chi Minh city, Vietnam from August 2021 to June 2023. Patients with acute BAO who underwent endovascular treatment within 24 h from symptom onset were included (thrombectomy alone or bridging with intravenous alteplase). The baseline characteristics and outcomes were analyzed and compared between patients with and without ICAD. Good functional outcome was defined as mRS ≤3 at 90 days. Results: Among the 208 patients enrolled, 112 (53.8%) patients were categorized in the ICAD group, and 96 (46.2%) in the non-ICAD group. Occlusion in the proximal segment of the basilar artery was more common in patients with ICAD (55.4% vs. 21.9%, p < 0.001), whereas the distal segment was the most common location in the non-ICAD group (58.3% vs. 10.7%, p < 0.001). Patients in the ICAD group were more likely to undergo treatment in the late window, with a higher mean onset-to-treatment time compared to the non-ICAD group (11.6 vs. 9.5 h, p = 0.01). In multivariable logistic regression analysis, distal segment BAO was negatively associated with ICAD (aOR 0.13, 95% CI: 0.05–0.32, p < 0.001), while dyslipidemia showed a positive association (aOR 2.44, 95% CI: 1.15–5.17, p = 0.02). There was a higher rate for rescue stenting in the ICAD compared to non-ICAD group (15.2% vs. 0%, p < 0.001). However, no significant differences were found between the two groups in terms of good outcome (45.5% vs. 44.8%, p = 0.91), symptomatic hemorrhage rates (4.5% vs. 8.3%, p = 0.25), and mortality (42% vs. 50%, p = 0.25). Conclusion: ICAD was a common etiology in patients with BAO. The location segment of BAO and dyslipidemia were associated with ICAD in patients with BAO. There was no difference in 90-day outcomes between BAO patients with and without ICAD undergoing endovascular therapy.

This study, conducted at 115 People’s Hospital in Ho Chi Minh City, Vietnam, aimed to understand the impact of intracranial atherosclerotic disease (ICAD) on acute basilar artery occlusion (BAO). We compared characteristics and treatment outcomes in BAO patients with and without ICAD. For almost 2 years, we enrolled BAO patients who received recanalization therapy within 24 h from onset, either through mechanical thrombectomy alone or thrombectomy bridging with intravenous alteplase. Outcomes were assessed based on mRS ≤3 at 90 days.

Among the 208 patients, 112 (53.8%) were diagnosed with ICAD, while 96 (46.2%) were not. ICAD patients more often had proximal BAO, while non-ICAD cases were more common in the distal segment. Patients with ICAD undergoing mechanical thrombectomy had longer onset-to-treatment times and tended to show delayed functional improvement. Additionally, ICAD patients were less likely to have distal BAO but more likely to have dyslipidemia. Rescue stenting was more common in the ICAD group. However, there were no significant differences were found between the two groups in terms of good functional outcome, symptomatic hemorrhage, or mortality.

In conclusion, ICAD was identified as a common factor in BAO cases, with specific associations with occlusion location and dyslipidemia. Importantly, there was no distinction in the 90-day outcomes between BAO patients with and without ICAD undergoing endovascular therapy. This insight contributes to our understanding of the complexities surrounding BAO and informs potential interventions.

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