Acute Basilar Artery Occlusion (BAO) results in high rate of morbidity and mortality. CHOICE is a randomized controlled trials demonstrated clinical benefit of intra-arterial thrombolysis after successful mechanical thrombectomy compared to placebo. Studies are needed to understand the generalizability of the findings of this trial to other vascular territories.

PC-SEARCH is a large multi-centered retrospective registry of consecutive acute BAOs treated with thrombectomy with contributions from eight high-volume centers across the United States from July 2015 – December 2021. Patients were included in this registry if they received mechanical thrombectomy or intra-arterial thrombolysis within 24 hours of last seen normal. Registry includes data from baseline characteristics, pre- and intra- procedural data, radiographic and clinical outcomes. Good clinical outcomes were defined as mRS ≤ 3. A subgroup of patients who were treated with IA tPA during or after thrombectomy and compared them to patients who did not receive IA tPA. Logistic regression was performed to evaluate the safety of IA tPA.

PC-SEARCH registry captured 519 patients with 28 (5.4%) patients receiving IA-tPA. The IA tPA group had similar median age (66 vs 65, p=0.82), NIHSS (18 vs 17,  p value 0.5), and rate of IV tPA administration (21% vs 26%,  p value 0.48) to the no IA tPA group. Other baseline characteristics were balanced.  Forty-five percent of patients reached mRS ≤3 with overall mortality rate of 41.4% at 90 days. Multivariate analysis shows IA-tPA was associated with symptomatic intracranial hemorrhage (OR 5.20, CI 1.60 – 16.84; p = 0.006). Good clinical outcomes were not affected by IA-tPA (42 vs 45%, p value 0.83).

Intra-arterial thrombolysis was associated with intracranial hemorrhage in acute basilar artery occlusion patients who underwent thrombectomy with no clinical benefit.