First-pass effect after acute basilar artery occlusion: a comparison of mechanical thrombectomy techniques
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Mechanical thrombectomy (MT) is effective for acute basilar artery occlusion (BAO), but the optimal technique for rapid recanalization and improved outcomes remains unclear. OBJECTIVE: We compared stent retriever (SR), contact aspiration (CA), and combined SR plus CA techniques as first-line approaches during MT for BAO. METHODS: We emulated a hypothetical trial comparing CA, SR, and combined technique as first-line in BAO patients. The primary outcome was first-pass effect (FPE), defined as modified Thrombolysis in Cerebral Infarction (mTICI) 3 with one pass of MT. Secondary outcomes included modified FPE (mFPE), functional outcome at 90 days, successful recanalization, and safety outcomes. We used inverse probability weighting (IPW) adjusted for prespecified covariates. RESULTS: The study included 960 BAO patients: 570 treated with CA, 268 with SR, and 122 with combined technique as the first approach. After applying IPW, SR was associated with lower odds of FPE (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.90) and of mFPE (aOR 0.48, 95% CI 0.33 to 0.70) compared with CA. No differences were found between the combined technique and either SR or CA. A 90-day modified Rankin Scale (mRS) 0-3 after mFPE was less frequent with SR (aOR 0.57, 95% CI 0.38 to 0.85) and with combined technique (aOR 0.50, 95% CI 0.28 to 0.89) compared with CA. Additionally, combined technique showed lower odds of mRS 0-1 at 90 days compared with CA (aOR 0.56, 95% CI 0.33 to 0.94). CONCLUSIONS: In BAO patients, CA was more effective than SR for complete and successful recanalization after first pass and resulted in better outcomes after mFPE as compared with other techniques. Less traumatic approaches might be preferred as first-line in BAO.
Authors: Ettore Nicolini, Antonio Ciacciarelli, Valentina Saia, Giovanni Pracucci, Luca Milonia, Elena Barrile, Manuela De Michele, Ilaria Casetta, Enrico Fainardi, Fabrizio Sallustio, Patrizia Nencini, Stefano Vallone, Guido Bigliardi, Giancarlo Salsano, Tiziana Benzi Markushi, Francesca Gatti, Francesco Cordici, Andrea Saletti, Alessandro De Vito, Vittorio Semeraro, Maria Pia Prontera, Arianna Rustici, Andrea Zini, Arianna Camilli, Nicola Loizzo, Antioco Sanna, Elena Coco, Roberto Menozzi, Alessandro Pezzini, Domenico Sergio Zimatore, Marco Petruzzellis, Guido A Lazzarotti, Mirco Cosottini, Valerio Da Ros, Marina Diomedi, Sandra Bracco, Rossana Tassi, Michele Besana, Alessia Giossi, Mauro Bergui, Manuel Cappellari, Salvatore Mangiafico, Danilo Toni
Institutions: Sapienza University of Rome, Policlinico Umberto I, Ospedale Santa Corona, University of Florence, Arcispedale Sant'Anna, Azienda Ospedaliero-Universitaria Careggi, Azienda Ospedaliero-Universitaria di Modena, Ospedale Policlinico San Martino, Ospedale “M. Bufalini” di Cesena, Ospedale SS. Annunziata, Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore Carlo Alberto Pizzardi, Policlinico San Matteo Fondazione, Fondazione Istituto Neurologico Nazionale Casimiro Mondino, University of Parma, Ospedale di Parma, Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari, Azienda Ospedaliera Universitaria Pisana, University of Pisa, University of Rome Tor Vergata, Azienda Ospedaliera Universitaria Senese, Azienda Socio Sanitaria Territoriale di Cremona, University of Turin, Azienda Ospedaliera Universitaria Integrata Verona, Istituto Neurologico Mediterraneo
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Funder: Ministero della Salute
Award: G1023738224
OpenAlex ID: W7166642334