Endovascular Therapy for Acute Basilar Artery Occlusion With Large Ischemic Core

Efficacy and Safety of Endovascular Therapy for Acute Basilar Artery Occlusion With Large Ischemic Core: A Prospective, Multicenter, Randomized Controlled Trial

Acute basilar artery occlusion is associated with high mortality and severe disability. Previous randomized trials have demonstrated the benefit of endovascular therapy in selected patients with basilar artery occlusion; however, patients with large ischemic core, commonly defined by low posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), remain underrepresented and the benefit-risk profile of endovascular therapy in this subgroup is uncertain.

This prospective, multicenter, randomized, open-label, blinded-endpoint trial will evaluate the efficacy and safety of endovascular therapy plus best medical management compared with best medical management alone in patients with acute basilar artery occlusion within 24 hours from symptom onset or last known well and pc-ASPECTS <7. Eligible participants will be randomized in a 1:1 ratio to receive endovascular therapy plus best medical management or best medical management alone. The primary outcome is favorable functional outcome, defined as a modified Rankin Scale score of 0 to 3 at 90 days.

Study Overview

• Status: Not yet recruiting
• Conditions: Acute Ischemic Stroke; Basilar Artery Occlusion; Large Ischemic Core
• Intervention / Treatment: Procedure: Endovascular Therapy; Other: Best Medical Management

Detailed Description

This is a prospective, multicenter, randomized, open-label, parallel-group, blinded-endpoint clinical trial. Patients aged 18 to 80 years with acute posterior circulation ischemic stroke, angiographically confirmed basilar artery occlusion, pc-ASPECTS <7 on CT/CTA source images or MRI-DWI, baseline NIHSS score ≥6, and randomization within 24 hours from symptom onset or last known well will be enrolled.

Participants will be randomly assigned in a 1:1 ratio to either endovascular therapy plus best medical management or best medical management alone. Randomization will be performed using a centralized randomization system with stratified permuted blocks. Stratification factors include study center, baseline NIHSS severity category, and onset-to-randomization time window.

Patients in both groups may receive standard intravenous thrombolysis if eligible according to current guidelines. Endovascular therapy may include stent retriever thrombectomy, direct aspiration thrombectomy, or combined techniques, at the discretion of the treating neurointerventionalist.

The primary efficacy endpoint is the proportion of patients achieving a modified Rankin Scale score of 0 to 3 at 90 days. Secondary endpoints include modified Rankin Scale score of 0 to 2 at 90 days, ordinal shift analysis of the modified Rankin Scale, changes in NIHSS and GCS scores, imaging outcomes, quality of life assessed by EQ-5D, and Barthel Index at 90 days. Safety outcomes include symptomatic intracranial hemorrhage, any intracranial hemorrhage, mortality, procedure-related complications, and serious adverse events.

• Study Type: Interventional
• Enrollment (Estimated): 256
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Chunrong Tao, PhD; Phone Number: +8662284079; Email: chunrongtao@126.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

- Clinical symptoms or imaging findings suggestive of acute posterior circulation ischemic stroke.

Basilar artery occlusion confirmed by CTA, MRA, or DSA. Posterior circulation ASPECTS <7 on CT, CTA source images, or MRI-DWI. Age 18 to 80 years. Time from symptom onset or last known well to randomization within 24 hours. Written informed consent obtained from the patient or legally authorized representative.

Baseline NIHSS score ≥6 before randomization.

Exclusion Criteria:

- Pre-stroke modified Rankin Scale score ≥3. Pregnancy or lactation. Known allergy to contrast agents or nickel-titanium alloy. Current participation in another clinical trial. Systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg that cannot be controlled with antihypertensive therapy.

Known hereditary or acquired bleeding diathesis, coagulation factor deficiency, or current oral anticoagulant use with INR >1.7.

Blood glucose <50 mg/dL or >400 mg/dL, platelet count <50 × 10^9/L, or hematocrit <25%.

Life expectancy less than 1 year. Inability to complete 90-day follow-up. Definite history of cerebral vasculitis. Pre-existing neurological or psychiatric disorder that may interfere with neurological or functional assessment.

Intracranial hemorrhage on CT or MRI, except for cerebral microbleeds <5 mm on MRI.

Vascular tortuosity, anatomical variation, or arterial dissection on CTA, MRA, or DSA that precludes endovascular treatment.

Intracranial tumor, except for small meningioma.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Endovascular Therapy Plus Best Medical Management; Participants assigned to this group will receive endovascular therapy in addition to best medical management. Endovascular therapy may include stent retriever thrombectomy, direct aspiration thrombectomy, or combined techniques, according to the vascular anatomy, thrombus characteristics, and operator judgment. Eligible patients may receive intravenous thrombolysis before endovascular therapy according to standard clinical guidelines.	Procedure: Endovascular Therapy; Endovascular therapy consists of mechanical thrombectomy using stent retriever, direct aspiration, or combined techniques with the goal of achieving rapid and effective reperfusion of the occluded basilar artery.; Other Names: Mechanical thrombectomy
Active Comparator: Best Medical Management Alone; Participants assigned to this group will receive best medical management according to current stroke guidelines. Eligible patients within the intravenous thrombolysis time window may receive standard-dose intravenous thrombolysis. Other medical treatment may include antithrombotic therapy, risk factor management, blood pressure management, and supportive stroke care according to local and guideline-based practice.	Other: Best Medical Management; Best medical management includes intravenous thrombolysis when eligible, antithrombotic therapy, standard stroke unit care, management of vascular risk factors, blood pressure control, and supportive care according to current clinical guidelines.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Favorable Functional Outcome at 90 Days	Proportion of participants with a modified Rankin Scale score of 0 to 3 at 90 days. The modified Rankin Scale ranges from 0 to 6, with 0 indicating no symptoms, 5 indicating severe disability, and 6 indicating death.	90 days after randomization

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Excellent Functional Outcome at 90 Days	Proportion of participants with a modified Rankin Scale score of 0 to 2 at 90 days.	90 days after randomization
Successful Recanalization on CTA/MRA	Proportion of participants with successful vascular recanalization on follow-up CTA or MRA.	Within 72 hours
Ordinal Shift in Modified Rankin Scale Score	Distribution of modified Rankin Scale scores at 90 days analyzed across all ordinal categories.	90 days after randomization
Symptomatic Intracranial Hemorrhage	Occurrence of symptomatic intracranial hemorrhage after randomization according to the prespecified trial definition.	Within 36 hours after randomization
All-cause Mortality	Death from any cause.	90 days

Collaborators and Investigators

• Sponsor: The First Affiliated Hospital of University of Science and Technology of China
• Collaborators: Linyi People's Hospital; Dalian Municipal Central Hospital; Shanghai Minhang District Central Hospital; Fujian Zhangzhou hospital
• Investigators: Principal Investigator: Wei Hu, PhD, The First Affiliated Hospital of University of Science and Technology of China

Study record dates

Study Major Dates

• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): July 30, 2029
• Study Completion (Estimated): December 31, 2029

Study Registration Dates

• First Submitted: June 23, 2026
• First Submitted That Met QC Criteria: June 23, 2026
• First Posted (Actual): June 29, 2026

Study Record Updates

• Last Update Posted (Actual): June 29, 2026
• Last Update Submitted That Met QC Criteria: June 23, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Endovascular therapy; Mechanical thrombectomy; Basilar artery occlusion; Posterior circulation stroke; Large ischemic core
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke; Ischemic Stroke
• Other Study ID Numbers: USTC-BAO-LARGE-2025KY851

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Undecided. The individual participant data sharing plan will be determined after completion of the trial and publication of the primary results, in accordance with institutional policies and applicable regulations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No