Comparison of Aspiration and Stent Retriever in Acute Basilar Artery Occlusion: A Subanalysis of the K-NET Registry

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Objective: Recent studies of endovascular thrombectomy (EVT) for anterior circulation stroke have revealed that contact aspiration (CA) and stent retriever (SR) achieve equivalent rates of effective reperfusion, neurological outcomes, and incidence of complications. However, comparative studies on the safety and efficacy of these techniques, particularly in the setting of basilar artery occlusion (BAO), are still lacking. This study aimed to compare the efficacy and safety of CA and SR thrombectomy for BAO using multicenter registry data, and to identify factors associated with better functional outcomes.

Methods: This retrospective analysis was conducted using data from the K-NET registry. Of the 3954 patients enrolled in this registry, 179 underwent EVT for BAO. Among these, 71 patients were excluded because they were treated with both an aspiration catheter and an SR. As a result, 108 patients were included in the final analysis. Patients were divided into the following 2 groups based on the treatment device used: CA (n = 71) and SR (n = 37). Baseline characteristics, procedural details, and clinical outcomes were compared between the groups. Multivariate analysis was performed to identify independent predictors of good clinical outcomes, defined as a modified Rankin Scale (mRS) score of 0–2 or no worsening of pre-stroke mRS at 90 days.

Results: The CA group required significantly fewer passes and achieved faster recanalization compared with the SR group. Furthermore, complete recanalization (modified treatment in cerebral infarction score of 3) was more frequent in the CA group (80.3% vs 59.5%, p = 0.02). Multivariate analysis revealed that CA was independently associated with good clinical outcomes (odds ratio 4.71, 95% confidence interval 1.69–13.11, p <0.01). No significant difference was observed in hemorrhagic complications between the groups.

Conclusion: Patients who underwent CA showed procedural advantages over SR thrombectomy, including more rapid recanalization with fewer passes and a higher rate of complete recanalization. These factors were found to be associated with better functional outcomes at 90 days. Further randomized controlled trials are required to confirm these findings and establish the optimal treatment strategy for BAO.