Endovascular Treatment for Basilar Artery Occlusion: A Network Meta-analysis Comparing Time-to-treatment Windows and Medical Management (P6-4.001)

Objective To evaluate the impact of treatment timing on outcomes by comparing endovascular therapy (EVT) performed in the early (0–6 h) and late (>6 h) windows versus best medical treatment (BMT) in basilar artery occlusion (BAO) using a Bayesian network meta-analysis. Background BAO is an uncommon but highly morbid posterior-circulation stroke subtype, with high mortality and disability despite BMT. EVT has emerged as a viable option, but optimal patient selection and time-to-treatment window remain uncertain. Design/Methods PubMed, Cochrane Library, and Embase were searched for studies assessing EVT timing in BAO reporting ≥1 prespecified outcome. Primary efficacy endpoint was functional independence (mRS 0–2) at 90 days; safety endpoints were mortality and symptomatic intracranial hemorrhage (sICH). Direct pairwise meta-analyses were performed when available, followed by a Bayesian random-effects network meta-analysis comparing EVT 0–6 h, EVT >6 h, and BMT. Results are reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results Seven studies encompassing 3,951 BAO patients were included. EVT >6 h showed higher odds of functional independence versus BMT (OR: 2.21; 95% CrI: 1.05–4.73), whereas EVT 0–6 h was not significantly different from BMT (OR: 1.17; 95% CrI: 0.56–2.38). Treatment rankings favored EVT >6 h for functional independence. Mortality did not differ significantly for EVT 0–6 h (OR: 0.68; 95% CrI: 0.22–2.52) or EVT >6 h (OR: 0.78; 95% CrI: 0.20–2.32) versus BMT. sICH rates were also not significantly different for EVT 0–6 h (OR: 2.33; 95% CrI: 0.64–11.0) or EVT >6 h (OR: 3.25; 95% CrI: 0.73–12.7). Conclusions In BAO, EVT >6 h was associated with improved functional independence versus BMT, without significant differences in mortality or sICH. This likely reflects patient selection and device-era effects rather than a benefit of delaying reperfusion. Findings should not justify postponing treatment. Prospective studies directly comparing time windows with standardized selection criteria are needed. Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff . Disclosure: Ms. Oliveira has nothing to disclose. Dr. Maximiano has nothing to disclose. Mr. Carretta has nothing to disclose. Mr. Goncalves has nothing to disclose. Mr. Falcão has nothing to disclose. Dr. Mitre has nothing to disclose. Dr. Arend has nothing to disclose. Mr. Fernandes has nothing to disclose. Mr. Rodrigues Teixeira has nothing to disclose. Dr. OLIVEIRA has nothing to disclose. Prof. Morais has nothing to disclose. Prof. BARBOSA has nothing to disclose. Dr. GÜNKAN has nothing to disclose.