Abstract Background and aims The impact of endovascular thrombectomy in acute mild stroke due to basilar artery occlusion (BAO) remains uncertain. This meta-analysis aimed to assess the efficacy and safety of endovascular thrombectomy in patients with acute mild BAO stroke. Methods A comprehensive search was conducted across PubMed, Embase, and Web of Science databases from inception to August 5, 2025. Cohorts or clinical trials evaluating the effect of endovascular thrombectomy for acute mild BAO stroke, defined by a score on NIHSS ≤10, were included. The efficacy outcomes include was the proportion of patients achieving modified Rankin Scale (mRS) 0-1 at 90 days and the proportion of mRS 0-2. Safety measures included symptomatic intracranial hemorrhage (sICH) and mortality at 90 days. Results We identified 11 cohort studies, and no eligible clinical trial was found. A total of 3325 patients were included. There were 524 of 1169 patients (44.8%) in the endovascular thrombectomy group and 508 of 1497 patients (33.9%) in the standard medical management group achieving mRS 0-1 at 90 days (risk ratio RR, 1.23 95%CI, 1.06-1.43; P=0.007), but the proportions of patients with mRS 0-2 were similar between the groups (59.7% vs. 55.5%; RR, 1.05 95%CI, 0.99-1.11; P=0.13). There was no significant difference observed in sICH (RR, 1.55 95%CI, 0.62-3.87; P=0.35) or 90-day mortality (RR, 1.08 95%CI, 0.91-1.30, P=0.37). Conclusions Endovascular thrombectomy could significantly increase the likelihood of obtaining an excellent functional outcome in acute BAO strokes with an NIHSS≤10 in a real-world setting without increasing risks of sICH and mortality. Conflict of interest All authors have nothing to disclose.
Pan et al. (2026) studied this question.