Intracranial hemorrhage (ICH) is a dreaded complication in patients with large-vessel occlusion of the anterior circulation undergoing endovascular treatment (EVT). Prior studies have established that ICH, particularly symptomatic ICH, is associated with worse clinical outcomes and an increased risk of mortality compared with no ICH in patients with proximal artery occlusion of the anterior circulation treated with EVT [1], [2], [3], [4]. Moreover, mounting evidence suggests that even asymptomatic ICH can be associated with unfavorable functional outcomes [3], [4], [5].

Recently, two multicenter randomized clinical trials, the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) [6] and Basilar Artery Occlusion Chinese Endovascular (BAOCHE) [7] trials, demonstrated the superiority of EVT over medical management alone for acute vertebrobasilar artery occlusion (VBAO). EVT may soon be recommended as a standard of care for patients with acute VBAO based on growing evidence of its benefits. However, knowledge regarding the relationship between hemorrhagic complications and functional outcomes in patients with acute VBAO undergoing EVT is scarce. A better understanding of hemorrhagic complications associated with clinical outcomes could provide guidance for optimal management in current clinical practice.

This study aimed to investigate the association between ICH and clinical outcomes in patients with acute VBAO after EVT, using data from the Acute Posterior Circulation Ischemic Stroke Registry (PERSIST).