The HALF-IT score: proposing a simplified mechanical thrombectomy triage tool for basilar artery occlusion
5 affiliations
- 1Department of Vascular and Endovascular Neurology, Indiana University School of Medicine
- 2Department of Neuroscience, Bon Secours Mercy Health St. Vincent Hospital
- 3Department of Neuroendovascular Surgery, Ochsner Clinic Foundation Lafayette General Hospital
- 4Department of Neuroendovascular Surgery, HCA Houston Healthcare Kingwood
- 5Department of Vascular and Endovascular Neurology, University of California
Abstract
Background: Basilar artery occlusion (BAO) is a devastating subtype of stroke with poor prognosis. Current patient selection tools for endovascular thrombectomy (EVT) are multi-tiered with interrater variability and limited validation studies. The HALF-IT score is a novel, simplified, dichotomized triaging tool focusing solely on the brainstem level. This study investigated the utility of the HALF-IT score to predict functional outcomes of EVT in patients with BAO.
Methods: We conducted a multicenter, retrospective, cohort study including patients with acute BAO presenting to four comprehensive stroke centers between 2021–2025. Acute infarction of ≥50% of any brainstem section on any axial or coronal slice of MRI was considered HALF-IT positive, whereas < 50% was considered HALF-IT negative. The primary efficacy outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0–3 at 90 days; functional independence (mRS 0–2) was analyzed as a secondary outcome. Reperfusion was graded with the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Primary safety endpoints included symptomatic intracranial hemorrhage at 24 h and all-cause mortality at 90 days. Multivariable logistic regression was performed to identify independent predictors of the primary efficacy outcome.
Results: 37 patients (23 HALF-IT negative; 14 HALF-IT positive) met the inclusion criteria. The rate of 90-day mRS 0–3 was significantly lower in the HALF-IT positive compared with HALF-IT negative group [14.3% vs. 68.2%, OR 0.08 (0.01–0.45), p = 0.004]. HALF-IT positive status remained associated with a lower rate of 90-day mRS 0–3 after adjusting for age, initial NIHSS, onset-to-reperfusion time, intravenous thrombolysis administration complete reperfusion (final mTICI 3) [adjusted OR 0.02, 95% CI 0–0.84, p = 0.02]. Safety events were numerically higher in the HALF-IT positive group but the difference did not reach statistical significance. The two groups differed substantially at baseline in age, presenting NIHSS, and intravenous thrombolysis exposure, whereas stroke etiology ( p = 0.28) and level of basilar occlusion ( p = 0.63) were similarly distributed.
Conclusion: In this small, retrospective, hypothesis-generating cohort, HALF-IT positivity was associated with worse 90-day functional outcomes after EVT for BAO. Further prospective validation in larger cohorts is required before the score can inform treatment decisions.
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BibTeX
@article{jones2026halfit,
title = {{The HALF-IT score: proposing a simplified mechanical thrombectomy triage tool for basilar artery occlusion}},
author = {Ann Marie Jones and Zain Tariq and Yazan Ashouri and Amit Chaudhari and Mohammad AlMajali and Mohamad Ezzeldin and Mustafa Abdul Kareem and Ahmad R. Awwad and Gregory Wong and Amir M. Molaie and Borja Sanz Cuesta and Jeffrey L. Saver and Kaustubh Limaye and Osama O. Zaidat},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1915436},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1915436/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The HALF-IT score: proposing a simplified mechanical thrombectomy triage tool for basilar artery occlusion
AU - Ann Marie Jones
AU - Zain Tariq
AU - Yazan Ashouri
AU - Amit Chaudhari
AU - Mohammad AlMajali
AU - Mohamad Ezzeldin
AU - Mustafa Abdul Kareem
AU - Ahmad R. Awwad
AU - Gregory Wong
AU - Amir M. Molaie
AU - Borja Sanz Cuesta
AU - Jeffrey L. Saver
AU - Kaustubh Limaye
AU - Osama O. Zaidat
PY - 2026
DA - 2026/10/14
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1915436
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1915436/full
AB - Background: Basilar artery occlusion (BAO) is a devastating subtype of stroke with poor prognosis. Current patient selection tools for endovascular thrombectomy (EVT) are multi-tiered with interrater variability and limited validation studies. The HALF-IT score is a novel, simplified, dichotomized triaging tool focusing solely on the brainstem level. This study investigated the utility of the HALF-IT score to predict functional outcomes of EVT in patients with BAO. Methods: We conducted a multicenter, retrospective, cohort study including patients with acute BAO presenting to four comprehensive stroke centers between 2021–2025. Acute infarction of ≥50% of any brainstem section on any axial or coronal slice of MRI was considered HALF-IT positive, whereas < 50% was considered HALF-IT negative. The primary efficacy outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0–3 at 90 days; functional independence (mRS 0–2) was analyzed as a secondary outcome. Reperfusion was graded with the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Primary safety endpoints included symptomatic intracranial hemorrhage at 24 h and all-cause mortality at 90 days. Multivariable logistic regression was performed to identify independent predictors of the primary efficacy outcome. Results: 37 patients (23 HALF-IT negative; 14 HALF-IT positive) met the inclusion criteria. The rate of 90-day mRS 0–3 was significantly lower in the HALF-IT positive compared with HALF-IT negative group [14.3% vs. 68.2%, OR 0.08 (0.01–0.45), p = 0.004]. HALF-IT positive status remained associated with a lower rate of 90-day mRS 0–3 after adjusting for age, initial NIHSS, onset-to-reperfusion time, intravenous thrombolysis administration complete reperfusion (final mTICI 3) [adjusted OR 0.02, 95% CI 0–0.84, p = 0.02]. Safety events were numerically higher in the HALF-IT positive group but the difference did not reach statistical significance. The two groups differed substantially at baseline in age, presenting NIHSS, and intravenous thrombolysis exposure, whereas stroke etiology ( p = 0.28) and level of basilar occlusion ( p = 0.63) were similarly distributed. Conclusion: In this small, retrospective, hypothesis-generating cohort, HALF-IT positivity was associated with worse 90-day functional outcomes after EVT for BAO. Further prospective validation in larger cohorts is required before the score can inform treatment decisions.
SN - 1664-2295
ER -