To investigate the impacts of different basilar artery bending length (BL) on mechanical thrombectomy of patients with acute basilar artery occlusion (ABAO).

The clinical and imaging data of 110 ABAO patients admitted to the Neurology Department of Xuyi County People's Hospital and the Interventional Radiology Department of Jiangsu Provincial People's Hospital from January 2018 to December 2021 were retrospectively analyzed. According to the BL of basilar artery, patients were divided into non-severe basilar artery tortuosity group (60 cases) and severe basilar artery tortuosity group (50 cases). BL of basilar artery was analyzed on DSA. The baseline data, mechanical thrombectomy and prognosis of 2 groups were compared to analyze the influence of severe basilar artery tortuosity on mechanical thrombectomy.

There were significant differences among male, hypertension, hyperlipidemia, use of intermediate catheters, large artery atherosclerosis, cardiac embolism, basal artery occlusion of lower segment, combined with angioplasty, baseline National Institute of Health stroke scale score, and recanalization rate between the non-severe basilar artery tortuosity group and the severe basilar artery tortuosity group (P<0.05). Multivariate Logistic regression analysis of risk factors for basilar artery recanalization failure showed that: basilar artery tortuosity (OR=1.315, 95%CI: 1.017-1.700, P=0.037) and times of thrombectomy (OR=3.167, 95%CI: 1.626-6.168, P=0.001) were independent risk factors for recanalization failure of mechanical thrombectomy.

Severe basilar artery tortuosity is not correlated with symptomatic intracranial hemorrhage, mortality rate and the modified Rankin scale score at 90 d in patients with ABAO treated with mechanical thrombectomy, and severe basilar artery tortuosity may lead to recanalization failure.