EVT for Basilar Artery Occlusion

Question

Accepted Answer

Early basilar EVT trials BEST (2020, stopped early; substantial crossover) and BASICS (2021, neutral; 80% of controls received IV alteplase) did not establish benefit. Two later Chinese trials, ATTENTION (2022, 0–12 h) and BAOCHE (2022, 6–24 h, stopped early for benefit), both showed improved functional outcomes with EVT. AHA/ASA 2026 §4.7.3 recommends basilar EVT within 24 h of onset for baseline mRS 0–1, NIHSS ≥10 and PC-ASPECTS ≥6 (COR 1, LOE A); for NIHSS 6–9 with the same criteria the effectiveness is not well established (COR 2b, LOE B-R). The guideline gives one 24 h window stratified by severity; the 12 h and 6–24 h figures are trial enrolment windows. BAOCHE was stopped early and effect size may be overestimated.

Does my basilar artery occlusion patient benefit from EVT?