IMPORTANCEEndovascular therapy (EVT) has been reported to be safe and effective in improving clinical outcomes among patients with acute basilar artery occlusion (ABAO). The benefits associated with EVT remain uncertain for patients with ABAO with severe symptoms (ie, National Institutes of Health Stroke Scale [NIHSS] score Ն 21). OBJECTIVES To assess the outcomes associated with EVT and identify factors associated with outcomes among patients with ABAO and severe symptoms. DESIGN, SETTING, AND PARTICIPANTS This prospective, nationwide cohort study was conducted using data from January 2014 to May 2019 in China from the Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry (BASILAR). Included patients had ABAO and underwent EVT or standard medical treatment (SMT) alone in routine clinical practice. Patients were dichotomized into severe symptoms (ie, NIHSS score Ն 21) and minor to moderate symptoms (NIHSS score < 21) groups. Patients were followed up for 90 days. Data were analyzed from December 2020 through June 2021.EXPOSURES EVT with SMT vs SMT alone. MAIN OUTCOMES AND MEASURES The primary outcome was improvement in modified RankinScale (mRS) score at 90 days, defined as a decrease by 1 grade in mRS score. Secondary outcomes included favorable functional outcome (ie, mRS score, 0-3) and mortality. RESULTS Among 542 patients with ABAO and severe symptoms (median [IQR] age,[65][66][67][68][69][70][71][72][73][74] years; 147 [27.1%] women), 431 patients (79.5%) received EVT and 111 patients (20.5%) received SMT.

The relationship between the volume of sphenoid sinus (SS) and the prevalence of internal carotid artery (ICA) and optic nerve (ON) protrusions in the SS was studied by using high-resolution CT imaging. The ICA and ON protrusions in SS were observed in randomly selected normal head CT scanning images from 350 adult subjects. According to the incidence of ICA protrusion, three groups were divided into no ICA protrusion (70.75%), unilateral protrusion (8.68%) and bilateral protrusions (20.57%). The ON protrusion accounted for 16% in 350 subjects and accompanied absolutely with ICA protrusion, but ICA protrusion appeared without accompanying with ON protrusion. The SS volume depended upon the protrusions in it and showed statistical differences, without ICA protrusion, the smallest size (11.16 ± 1.60) cm 3 ; the unilateral protrusion, medium size (14.20 ± 1.80) cm 3 and the bilateral protrusion, the largest size (25.03 ± 2.21) cm 3 . By observing 3D reconstructed models of ON and SS, we found ON was adjacent to SS (46%) and to posterior ethmoid sinuses (44%). The current study indicates that SS volume is varied with numbers of the protrusions and that ON location varies with the pneumatization of SS. Our results provide an anatomical basis to the surgeries for SS and its surrounding structures.

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