Bridging therapy versus mechanical thrombectomy alone in patients with basilar artery occlusion and mild symptoms: a retrospective observational study

Background: The safety and efficacy of bridging therapy, which combines intravenous thrombolysis (IVT) with mechanical thrombectomy (MT), have not been fully explored in patients with basilar artery occlusion (BAO) and mild symptoms. This study aims to evaluate these factors in patients with BAO and an NIHSS score of less than 10. Methods: We conducted a multicenter retrospective observational study involving consecutive BAO patients with NIHSS < 10 from 10 European stroke centers between January 2017 and December 2024. We used inverse probability of treatment weighting (IPTW) to balance clinical variables. Primary safety outcomes included parenchymal hematoma (PH1/PH2) and in-hospital death. Secondary efficacy outcomes included successful recanalization after MT and the 90-day functional outcome. Results: A total of 134 patients were included. Bridging therapy did not increase the risk of PH (RR = 0.963; 95% CI 0.185-5.020; p = 0.965) or in-hospital death (RR = 0.620; 95% CI 0.174-1.980; p = 0.434). Additionally, IVT plus MT showed no significant improvement of the 90-day mRS score (ATE -0.187; 95% CI -1.0690.694; p = 0.675) or rates of 90-day mRS 0-2 (RR 1.192; 95% CI 0.483-3.011; p = 0.704) and 03 (RR 1.997; 95% CI 0.738-5.867; p = 0.186). No effect of IVT was observed on the rate of successful recanalization (RR 2.659; 95% CI 0.663-13.518; p = 0.190). Conclusions: Bridging therapy appears to be safe for BAO patients with mild symptoms, but it does not provide additional benefits for functional outcomes or efficient recanalization rates.