Abstract
OBJECTIVE: To compare the efficacy and prognosis of endovascular treatment (EVT) versus best medical management (BMM) in acute basilar artery occlusion (aBAO). METHODS: We retrospectively analyzed 120 aBAO patients treated at the Affiliated Zhangjiagang Hospital of Soochow University (Jan 2021-Dec 2024), with 60 patients in each group. Baseline characteristics were comparable. Functional recovery was assessed by mRS and EQ-5D at days 0, 30, and 90. Safety outcomes included symptomatic intracranial hemorrhage, 90-day mortality, and functional deterioration. Neurological function and imaging were evaluated using NIHSS and PC-ASPECTS. RESULTS: EVT showed significantly better mRS at 30 and 90 days (3.0 ± 1.3, 2.5 ± 1.2 vs. 3.8 ± 1.4, 3.3 ± 1.5; p = 0.042, 0.025) and higher EQ5D scores (57.6 ± 19.8, 78.8 ± 20.3 vs. 51.5 ± 18.6, 69.6 ± 21.2, p = 0.038, 0.015). NIHSS scores were lower in EVT at all time points (p < 0.001), PC-ASPECTS higher (7.8 ± 1.2 vs. 6.4 ± 1.5; p = 0.001), and basilar artery recanalization rate greater (85% vs. 60%; p = 0.002). Safety outcomes showed no significant differences: symptomatic hemorrhage (10% vs. 15%; p = 0.45), 90-day mortality (12% vs. 18%; p = 0.38), functional deterioration (8% vs. 14%; p = 0.32). CONCLUSION: EVT significantly improves functional recovery and neurological outcomes in aBAO and demonstrates higher recanalization rates, with comparable safety to BMM, supporting EVT as the preferred treatment option.