Endovascular therapy (EVT) for vertebrobasilar artery occlusion (VBAO) has shown encouraging results in recent randomized trials, yet functional outcomes remain highly variable despite high rates of recanalization. This discrepancy suggests the need to better understand the factors that determine whether reperfusion translates into meaningful neurological recovery. In this review, we summarize current evidence on clinical, imaging, and procedural predictors associated with prognosis following EVT for VBAO. Clinical severity and level of consciousness provide initial insight but are insufficient for reliable decision-making. Imaging—particularly the assessment of brainstem involvement, collateral circulation, and perfusion status-emerges as the most decisive predictor of outcome and an important determinant of futile vs. effective recanalization. Procedural factors, including first-pass effect, treatment timing, device strategy, and anesthesia selection, further influence the likelihood of achieving functional improvement. By integrating these multidimensional predictors, this review proposes a comprehensive framework to support more precise patient selection and guide future research aimed at improving outcomes in posterior circulation stroke.

Background: Post-stroke depression (PSD) is one of the most common neuropsychiatric complications among stroke survivors, with a substantial impact on functional recovery and quality of life. This study aimed to investigate the effect of flupentixol and melitracen tablets combined with repetitive transcranial magnetic stimulation (rTMS) on patients with post-stroke depression (PSD) and analyze the differences in the key factors of the 17-item Hamilton Depression Scale (HAMD ₁₇ ) scores. Methods: We conducted a retrospective analysis of 121 patients with PSD, including 57 patients who used the flupentixol and melitracen tablets alone and 64 patients who additionally received rTMS. General information was assessed. Follow-up indices after treatment included P300, National Institutes of Health Stroke Scale (NIHSS), HAMD ₁₇ , and the Barthel Index (BI) and Pittsburgh Sleep Quality Index (PSQI) questionnaire. Observable mood (OM), cognitive symptoms (CS) and neurovegetative symptoms (NS), the three dimensions of HAMD ₁₇ was also analyzed. The concentrations of 5-hydroxytryptamine (5-HT), norepinephrine (NE), neuropeptide Y (NPY) and brain-derived neurotrophic factor (BDNF) in the serum were measured during all time points. Results: There was significant difference in the amplitude and latency of P300 and NS after 2 weeks and 4 weeks treatment between the groups, while there was significant difference in the concentrations of 5-HT, NE, NPY, BDNF and the scores of NIHSS, HAMD ₁₇ , BI, PSQI after 4 weeks treatment. The treatment outcomes at 4 weeks demonstrated statistically significant differences compared to those observed at 2 weeks both at control group and combination group. The results also indicated that the treatment in the combined group demonstrated superiority over that in the control group with respect to both onset time and therapeutic efficacy. Conclusion: Combination of flupentixol and melitracen tablets and rTMS could significantly improve the depressive symptoms of patients with PSD, NS was the symptom dimension most closely related to the therapeutic response. More importantly, the P300 parameter might provide an early and objective indicator of the neurophysiological changes associated with the treatment.