{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T18:15:22Z","timestamp":1778609722223,"version":"3.51.4"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The best revascularization strategy for acute ischemic stroke from isolated vertebral artery occlusion remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This retrospective, international, multicenter cohort study included patients from 30 comprehensive stroke centers across Europe (n=23), North America (n=5), and Asia (n=2) between 2016 and 2022. Eligible patients presented with acute ischemic stroke within 24 hours of last seen well and had imaging-confirmed isolated vertebral artery occlusion. Two treatment comparisons were analyzed: intravenous thrombolysis (IVT)-only versus conservative treatment (Cx), and endovascular treatment (EVT)\u00b1IVT versus medical management (Cx and IVT). The primary outcome was the shift in 3-month modified Rankin Scale (mRS) score; secondary outcomes included early neurological improvement (24-hour-delta National Institutes of Health Stroke Scale score), recanalization, early neurological deterioration of ischemic origin, symptomatic intracerebral hemorrhage, and 3-month mortality. Analyses were adjusted using inverse probability of treatment weighting (IPTW).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 494 patients, 143 (29%) received Cx, 218 (44%) IVT-only, and 133 (27%) EVT\u00b1IVT. Compared with Cx, IVT-only showed similar 3-month mRS score (IPTW-adjusted odds ratio [aOR] mRS shift score, 1.32 [95% CI, 0.80\u20132.18]), greater early neurological improvement (IPTW-adjusted-\u03b2 coefficient, \u22121 [95% CI, \u22122.05 to 0.05]), and higher recanalization rates (IPTW-aOR, 4.33 [95% CI, 1.36\u201313.78]). Compared with MM (=IVT+Cx), EVT\u00b1IVT was associated with an unfavorable mRS shift score (IPTW-aOR mRS shift score, 0.51 [95% CI, 0.35\u20130.74]), higher early neurological deterioration of ischemic origin (IPTW-aOR, 9.06 [95% CI, 2.86\u201328.67]), and symptomatic intracerebral hemorrhage (IPTW-aOR, 6.05 [95% CI, 1.14\u201332.1]) though recanalization was over 4-fold higher (OR, 4.64 [95% CI, 1.90\u201311.33]). Patients with National Institutes of Health Stroke Scale score \u226510 showed point estimates favoring EVT+IVT (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      =0.025).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>IVT-only appeared safe and was associated with better early recovery and recanalization. EVT\u00b1IVT showed overall worse outcomes, potentially due to increased early neurological deterioration of ischemic origin and symptomatic intracerebral hemorrhage rates, but may confer benefit in moderate-to-severe strokes, warranting prospective trials in symptomatic isolated vertebral artery occlusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.051675","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T09:00:12Z","timestamp":1773133212000},"page":"1149-1163","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes and Safety of Revascularization Approaches for Stroke Related to Isolated Vertebral Artery Occlusions (BRAVO)"],"prefix":"10.1161","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8494-5527","authenticated-orcid":true,"given":"Alexander","family":"Salerno","sequence":"first","affiliation":[{"name":"Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland (A.S., D.S., P. Michel)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9897-4561","authenticated-orcid":true,"given":"Vincent","family":"Dunet","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Switzerland (V.D., B.M., G.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3508-2176","authenticated-orcid":true,"given":"Marek","family":"Sykora","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Johns Hospital, Vienna, Austria (M.S., S.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1525-2019","authenticated-orcid":true,"given":"Philipp","family":"Baumgartner","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of Z\u00fcrich and University of Zurich, Switzerland (P.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6126-8305","authenticated-orcid":true,"given":"Visnja","family":"Padjen","sequence":"additional","affiliation":[{"name":"Neurology Clinic, University Clinical Centre of Serbia, Belgrade (V. Padjen)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5312-7206","authenticated-orcid":true,"given":"Guido","family":"Bigliardi","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Clinic, Ospedale Civile di Baggiovara, AOU Modena, Italy (G.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7254-0020","authenticated-orcid":true,"given":"Dylan","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Duke University School of Medicine, Durham, NC (D.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3594-2159","authenticated-orcid":true,"given":"Mirjam R.","family":"Heldner","sequence":"additional","affiliation":[{"name":"Stroke Unit, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5577-1775","authenticated-orcid":true,"given":"Christian H.","family":"Nolte","sequence":"additional","affiliation":[{"name":"Department of Neurology, Charit\u00e9-Universitatmedizin Berlin, Germany (C.H.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1545-8500","authenticated-orcid":true,"given":"Sami","family":"Curtze","sequence":"additional","affiliation":[{"name":"Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (S.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1486-4507","authenticated-orcid":true,"given":"Andrea","family":"Zini","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Italy (A.Z.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8198-7676","authenticated-orcid":true,"given":"Michael","family":"Nahhas","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Texas McGovern Medical School, Houston (M.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-1685","authenticated-orcid":true,"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Neurology Department, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0949-2422","authenticated-orcid":true,"given":"Henrik","family":"Gensicke","sequence":"additional","affiliation":[{"name":"Neurology and Neurorehabilitation, University Department of Geriatric Medicine, Felix Platter and University Hospital Basel, Switzerland (H.G., S.T.E.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4967-8336","authenticated-orcid":true,"given":"Lars","family":"Kellert","sequence":"additional","affiliation":[{"name":"Department of Neurology, Klinikum der Universit\u00e4t M\u00fcnchen, Ludwig-Maximilians-University, Munich, Germany (L.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3999-4992","authenticated-orcid":true,"given":"Jong S.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, South Korea (J.S.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1369-418X","authenticated-orcid":true,"given":"Christian","family":"Boehme","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Innsbruck, Austria (C.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0287-3967","authenticated-orcid":true,"given":"James E.","family":"Siegler","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8333-0352","authenticated-orcid":true,"given":"Paolo","family":"Machi","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Geneva University Hospital, Switzerland (P. 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