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Background The clinical significance of achieving complete (eTICI 3) versus near-complete (eTICI 2c) reperfusion after endovascular therapy (EVT) for basilar artery occlusion (BAO) remains uncertain. We evaluated the association between successful reperfusion grade and 90-day functional outcomes.Methods We performed a retrospective cohort study of patients with BAO who received intravenous thrombolysis (IVT) within 4.5 hours and were referred for EVT. The analysis included those who underwent EVT and achieved successful reperfusion (eTICI 2c-3). Baseline demographics, imaging scores, procedural metrics, and in-hospital outcomes were compared. Early neurological recovery was assessed using 24-hour NIHSS and change in NIHSS from baseline. The primary endpoint was 90-day mRS 0-3.Results We included 88 patients with final eTICI 2c (n=17, 19.3%) and eTICI 3 (n=71, 80.7%). The median age was 62.5 years (IQR 53.8-74.3), and median baseline NIHSS was 20 (IQR 13.0-28.0). Baseline characteristics were comparable between eTICI 2c and eTICI 3 groups, including age (64.0 vs 62.0 years, p=0.841), baseline NIHSS (19 vs 20, p=0.903), PC-ASPECTS (both median 10, p=0.505), and LKW-to-groin time (271 vs 213 minutes, p=0.171). First-pass effect occurred in 53.3% of eTICI 2c and 67.1% of eTICI 3 cases (p=0.473), with a median of 1 pass in both groups (p=0.499). Patients achieving eTICI 3 had significantly better early neurological recovery, with lower 24-hour NIHSS scores (median 4.0 [1-13] vs 14 [7-23], p=0.016) and greater 24 hour NIHSS improvement from baseline (−13.0 [−18 to −3] vs −6.0 [−9 to −3], p=0.026). Rates of intracranial hemorrhage were comparable (21.1% vs 17.6%, p=1.000), as were symptomatic hemorrhage rates (4.2% vs 11.8%, p=0.246). 90-day mRS 0-3 was comparable between groups.Conclusions Complete reperfusion was associated with greater early neurological improvement, however this did not translate to a significant difference in 90-day functional outcomes compared with eTICI 2c reperfusion in this cohort of BAO patients. Larger studies are needed to clarify whether incremental angiographic benefit translates into durable functional advantage in BAO.Disclosures K. Darko: None. R. Karamchandani: 1; C; GenenTech. J. Rhoten: None. M. Jayaraman: None. C. Sidebottom: None. B. Gross: None. A. Al-Bayati: None. A. Chinthala: None. A. Gajjar: None. J. Burkhardt: None. K. Scott: None. V. Srinivasan: None. M. Koneru: None. D. Vaishnav: None. S. Multani: None. T. Theofanis: None. R. Zand: None. S. Bahrami: None. J. Li: None. G. Defilipp: None. D. Strong: None. R. Torabi: None. K. Moldovan: None. R. Nogueira: 2; C; GenenTech. B. Bohnstedt: None. D. Wolman: None.