Endovascular Treatment in Acute Basilar Artery Occlusion Stroke: A Brief Practice Update From the Society of Vascular and Interventional Neurology

BACKGROUND: The Society of Vascular and Interventional Neurology Guidelines and Practice Standards committee established the "Brief Practice Update" format to provide up-to-date recommendations on focused relevant clinical questions. In this Brief Practice Update, we review current evidence and provide recommendations for endovascular treatment (EVT) in patients with acute large-vessel occlusion of the basilar artery. METHODS: The Society of Vascular and Interventional Neurology Guidelines and Practice Standards committee conducted a systematic review, including the recent randomized clinical trials of EVT for acute ischemic stroke attributable to basilar artery occlusion, and summarized relevant data to provide recommendations for clinical practice. The Guidelines and Practice Standards quality committee reviewed the findings to ensure adherence to the Society of Vascular and Interventional Neurology internal evidence evaluation guidelines before review by the Society of Vascular and Interventional Neurology board members for societal endorsement. RESULTS: Evidence favors EVT for basilar artery occlusion in comparison to medical management alone in patients with moderate to severe stroke. We formulated the level of evidence and the class of recommendation in the context of 5 clinical questions. CONCLUSIONS: In this brief practice statement, we share general recommendations on EVT for acute ischemic stroke attributable to large-vessel occlusion of the basilar artery. Recent randomized controlled trials, Basilar Artery Occlusion Chinese Endovascular (BAOCHE) trial and Endovascular Treatment for Acute Basilar-Artery Occlusion (ATTENTION), and a meta-analysis of all randomized controlled trials support EVT in patients with moderate to severe basilar artery occlusion stroke symptoms.