To better characterize symptomatic intracranial hemorrhage (sICH) in basilar artery thrombectomies.

sICH is one of the most feared complications in endovascular therapy in acute ischemic stroke. This is well described in large vessel occlusions (LVO) involving the anterior circulation, but not the posterior circulation.

We included all patients with acute ischemic stroke involving the basilar artery who underwent endovascular thrombectomy at a comprehensive stroke center from 2012-2019. sICH was defined as any type of intracranial hemorrhage with an increase of ≥4 NIHSS from baseline within 24 hours or leading to death. Data was analyzed using univariate tests and multivariate regression analysis.

A total of 100 basilar artery strokes underwent thrombectomy during the study period. Mean age was 64.6 +/-17 years and median NIHSS score was 20 (10-27). Mean time from last known well to arrival was 13.7 +/-17 hours and TICI >=2B was achieved in 90% (90). Of those with intracranial hemorrhage on interval CT head or MRI- intraparenchymal hemorrhage was present in 89% (34), subarachnoid hemorrhage in 8% (3), and intraventricular hemorrhage in 3% (1). sICH was found in 6% (6). Most common location of intracranial hemorrhage was 47% (18) in the cerebellum, 26% (10) in thalamus, 18% (7) in the occipital lobe, and 24% (9) in midbrain and pons. On multivariable regression analysis, predictors of any intracranial hemorrhage include lower pc-ASPECTS [OR-0.66 (0.46-0.95)]. Rate of mRS 0-2 at 90 days was 34% and mortality was 40%.