BEST-BAO
(2026)Objective
To test whether IV tPA plus EVT (bridging therapy) is superior to EVT alone, and whether EVT alone is non-inferior, in basilar artery occlusion stroke within 4.5 h.
Study Summary
• Primary 90-day mRS 0-2: 41.6% vs 40.7% (superiority failed; Pnoninf = 0.001).
• Final mTICI 2b-3: 49.7% vs 48.3% (NS).
• sICH 1.2% vs 1.2% (NS); 90-day mortality 37.1% vs 35.9% (NS).
• EVT alone was non-inferior to IV tPA + EVT in BAO.
• Final mTICI 2b-3: 49.7% vs 48.3% (NS).
• sICH 1.2% vs 1.2% (NS); 90-day mortality 37.1% vs 35.9% (NS).
• EVT alone was non-inferior to IV tPA + EVT in BAO.
Intervention
IV tPA + EVT (bridging) vs EVT alone
Inclusion Criteria
China. Basilar artery occlusion, NIHSS >=6, eligible for IVT and EVT within 4.5 h. ~27% transfer for EVT; tPA dwell time ~34 min.
Study Design
Arms: IV tPA + EVT vs EVT alone (stenting/angioplasty/IAT allowed)
Patients per Arm: Bridging n=178 vs EVT alone n=177 (total 355)
Outcome
• Primary 90-day mRS 0-2: 41.6% vs 40.7% (superiority failed; Pnoninf=0.001).
• Final mTICI 2b-3: 49.7% vs 48.3% (NS).
• sICH: 1.2% vs 1.2% (NS).
• 90-day mortality: 37.1% vs 35.9% (NS).
• Final mTICI 2b-3: 49.7% vs 48.3% (NS).
• sICH: 1.2% vs 1.2% (NS).
• 90-day mortality: 37.1% vs 35.9% (NS).