Endovascular Thrombectomy Exhibits Durable Benefit of Endovascular Thrombectomy in Acute Basilar Artery Occlusion: JAMA
China: Researchers have found in a new study that endovascular thrombectomy provides a durable benefit in patients with acute basilar artery occlusion.
At 3 years, endovascular thrombectomy (EVT) was associated with better long-term functional outcomes and lower mortality compared with best medical management alone, reinforcing EVT as the standard of care and highlighting the importance of timely access to thrombectomy services.
The findings are from the 3-year follow-up of the ATTENTION randomized clinical trial, published in JAMA Neurology by Wei Hu from the Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, and colleagues. While EVT has shown clear short-term benefits in basilar artery occlusion (BAO), its long-term effectiveness has remained uncertain until now.
Basilar artery occlusion is a severe form of ischemic stroke with high rates of death and long-term disability. Although thrombectomy has transformed outcomes in anterior circulation stroke, evidence supporting its sustained benefit in posterior circulation stroke has been limited. The ATTENTION trial was designed to evaluate whether early gains with EVT persist over several years.
This study represents a long-term extension of a multicenter, open-label, assessor-blinded randomized trial conducted across 36 comprehensive stroke centers in China. Between February 2021 and January 2022, 340 adults with imaging-confirmed acute BAO presenting within 12 hours of symptom onset were randomly assigned to receive EVT plus best medical management or medical therapy alone. Three-year follow-up data were available for 307 patients, including 203 in the thrombectomy group and 104 in the control group.
Patients assigned to EVT underwent contemporary endovascular procedures using stent retrievers, aspiration techniques, angioplasty, stenting, intra-arterial thrombolysis, or combinations of these approaches based on institutional practice. Functional outcomes were assessed using the modified Rankin Scale (mRS), with scores of 0 to 3 indicating the ability to walk and perform self-care independently.
The following were the key findings:
- At three years, 38.4% of patients treated with endovascular thrombectomy achieved an mRS score of 0 to 3, compared with 18.3% of those receiving medical management alone.
- Functional outcomes were significantly better in the thrombectomy group, indicating the sustained benefit of EVT.
- The overall distribution of mRS scores favored thrombectomy, reflecting long-term neurological improvement.
- Mortality increased over time in both treatment groups.
- Cumulative mortality at three years was significantly lower among patients who underwent endovascular thrombectomy compared with controls.
- Subgroup analysis showed a clear long-term benefit of EVT in patients younger than 70 years.
- No significant treatment advantage was demonstrated in patients aged 70 years or older.
- Further studies are needed to clarify the influence of age on long-term outcomes following EVT.
Overall, the study demonstrates that the benefits of endovascular thrombectomy in acute basilar artery occlusion extend well beyond the acute phase, with lasting improvements in function and survival. These results strengthen the evidence supporting EVT as standard therapy for BAO and highlight the need to expand timely access to thrombectomy services worldwide.
Reference:
Hu W, Tao C, Li R, et al. Endovascular vs Medical Treatment of Basilar Artery Occlusion: 3-Year Outcomes of the ATTENTION Randomized Clinical Trial. JAMA Neurol. Published online December 29, 2025. doi:10.1001/jamaneurol.2025.5077
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