Coronary stent implantation in acute basilar artery occlusion with underlying stenosis: potential for increased effectiveness in endovascular stroke therapy.

AIMS: Our aim was to study the effectiveness of coronary stent implantation during the endovascular treatment (EVT) of acute basilar artery occlusion (BAO) with occlusion-underlying intracranial atherosclerotic stenosis (ICAS). METHODS AND RESULTS: We retrospectively analyzed 91 consecutive BAO patients treated by EVT between February 2014 and January 2019 in a single, high-volume neurointerventional center. We studied the effect of immediate coronary stent implantation on the clinical outcome of BAO with occlusion-underlying stenosis. BAO patients with underlying ICAS (n=41) were characterized by longer symptom-onset-to-reperfusion times (231min vs. 173min p=0.0020), lower TICI 2b-3 reperfusion rates (65.85% vs. 90.00%p=0.0084), and higher overall mortality (HR:2.021 p=0.0417) compared to the BAO cases without ICAS (n=50). The patients undergoing stenting (n=18) had lower residual basilar artery (BA) stenosis (14.7% vs. 81.0% p<0.0001), higher chance for functional recovery (OR:7.6 p=0.0250) and higher chance of survival (HR:4,163; p=0.0026) compared to the BAO-ICAS cases treated without coronary stents (n=21). CONCLUSIONS: The immediate treatment of the occlusion-underlying stenosis with coronary stents and dual antiplatelet therapy (DAPT) in BAO was associated with improved overall survival and better functional outcomes.