Basilar artery occlusion (BAO) is a rare but severe form of ischemic stroke with high morbidity and mortality. Although recent randomized studies have demonstrated the benefits of endovascular thrombectomy (EVT) in acute BAO, a significant proportion of patients experience futile recanalization—defined as successful vessel recanalization with poor functional outcomes. The reasons behind this phenomenon, as well as potential predictors of successful recanalization and favorable long-term functional recovery, remain poorly understood. 

We conducted a retrospective analysis of patients with acute BAO treated with EVT at a comprehensive stroke center in Midwest. Data on demographics, clinical characteristics, procedural details, and outcomes were collected. Functional recovery was assessed using the modified Rankin Scale (mRS) at discharge and 3-month follow-up. Statistical analysis included Fisher’s exact test and ordinal logistic regression.

 A total of 51 patients (mean age 63.5) were analyzed. Large artery atherosclerosis was the most common etiology (40%). Complete recanalization (TICI ≥2b) was achieved in 88%of patients. Re-occlusion occurred in 24% of patients. After 30 days, 87% of patients undergoing EVT had poor outcomes (mRS ≥4), while 13% showed good outcomes (mRS 0-3). Mid-BAO and re-occlusion post EVT were significantly associated with good functional outcomes at 30 days (P=0.04, OR =7; and P=0.04, OR 0.2, respectively).