Endovascular treatment for basilar artery occlusion: A systematic review and meta‐analysis

BackgroundStent retriever thrombectomy has recently been found to be effective for anterior circulation strokes, but its efficacy for basilar artery occlusion (BAO) is unclear.ObjectiveTo carry out a systematic review and meta-analysis to analyze the available evidence for the use of stent retrievers for BAO.MethodsTwo independent reviewers searched six databases for studies reporting outcomes following endovascular treatment for BAO.ResultsA total of 17 articles (6 prospective and 11 retrospective) were included. The weighted mean age of patients was 67 years (range 59–82) and 59% were male. Thrombolytic drugs were administered intravenously and intra-arterially in 46% (range 0–88%) and 38% (range 0–90%) of patients, respectively. Weighted pooled estimates of successful recanalization (TICI 2b–3) and good outcome (modified Rankin Scale ≤2) were 80.0% (95% CI 70.7% to 88.0%; I2=80.28%; p<0.001) and 42.8% (95% CI 34.0% to 51.8%; I2=61.83%; p=0.002), respectively. Pooled mortality was 29.4% (95% CI 23.9% to 35.3%; I2=37.01%; p=0.087). Incidence of procedure-related complications and symptomatic hemorrhage was 10.0% (95% CI 3.7% to 18.3%; I2=61.05%; p=0.017) and 6.8% (95% CI 3.5% to 10.8%; I2=37.99%; p=0.08), respectively.ConclusionsStent retriever thrombectomy achieves a high rate of recanalization and functional independence while being relatively safe for patients with BAO. Future prospective studies with long-term follow-up are warranted.

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Presenting NIHSS predicts 90-day functional outcome after mechanical thrombectomy for basilar artery occlusion: A systematic review and meta-analysis

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.106199 ◽

2020 ◽

Vol 197 ◽

pp. 106199

Author(s):

Victor M. Lu ◽

Christopher C. Young ◽

Stephanie H. Chen ◽

Kyle P. O’Connor ◽

Michael A. Silva ◽

...

Keyword(s):

Systematic Review ◽

Functional Outcome ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion

Stroke and Vascular Neurology ◽

10.1136/svn-2021-001242 ◽

2021 ◽

pp. svn-2021-001242

Author(s):

Ximing Nie ◽

David Wang ◽

Yuehua Pu ◽

Yufei Wei ◽

Qixuan Lu ◽

...

Keyword(s):

Ischaemic Stroke ◽

Endovascular Treatment ◽

Basilar Artery ◽

Acute Ischaemic Stroke ◽

Functional Outcomes ◽

Meta Analysis ◽

Functional Independence ◽

Artery Occlusion ◽

Lower Percentage ◽

Basilar Artery Occlusion

Background and purposeIt remains controversial if endovascular treatment (EVT) can improve the outcome of patients with acute basilar artery occlusion (BAO). This study aims to compare the functional outcomes between EVT with and without intravenous thrombolysis (IVT) first in patients who had acute ischaemic stroke (AIS) due to BAO.MethodsPatients who had AIS with BAO who underwent EVT within 24 hours of onset were enrolled in this multicentre cohort study, and the efficacy and safety were compared between IVT+EVT and direct EVT. The primary outcome was 90-day functional independence. All outcomes were assessed with adjusted OR (aOR) from the multivariable logistic regression. In addition, a meta-analysis was performed on all recently published pivotal studies on functional independence after EVT in patients with BAO.ResultsOf 310 enrolled patients with BAO, 241 (78%) were treated with direct EVT and 69 (22%) with IVT+EVT. Direct EVT was associated with a worse functional outcome (aOR, 0.46 (95% CI 0.24 to 0.85), p=0.01). IVT+EVT was associated with a lower percentage of patients who needed ≥3 passes of stent retriever (10.14% vs 20.75%). The meta-analysis regression revealed a potential positive correlation between bridging with IVT first and functional independence (r=0.14 (95% CI 0.05 to 0.24), p<0.01).ConclusionsThis study showed that compared with direct EVT, EVT with IVT first was associated with better functional outcomes in patients with BAO treated within 24 hours of onset. The meta-analysis demonstrated similar favourable efficacy of IVT first followed by EVT in patients with BAO.

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Endovascular treatment versus standard medical treatment for acute basilar artery occlusion: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-040415 ◽

2020 ◽

Vol 10 (11) ◽

pp. e040415

Author(s):

Xuesong Bai ◽

Xiao Zhang ◽

Long Li ◽

Tao Wang ◽

Adam Andrew Dmytriw ◽

...

Keyword(s):

Systematic Review ◽

Scale Score ◽

Basilar Artery ◽

Observational Studies ◽

Meta Analysis ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Safety And Efficacy ◽

Effect Model ◽

Standard Medical Treatment

IntroductionAcute basilar artery occlusion (BAO) can cause posterior circulation stroke. There are two predominant therapies for BAO: standard medical treatment (SMT) and SMT plus endovascular thrombectomy (EVT). However, a conclusive systematic comparison of the safety and efficacy of SMT and those of SMT plus EVT for the treatment of BAO is lacking. Thus, a systematic review and meta-analysis is needed to evaluate the safety and efficacy of SMT and SMT plus EVT for the treatment of BAO.Methods and analysisThis protocol is drafted referring to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines. We will search eligible studies from four main databases including MEDLINE, Web of Science, Cochrane Library and Embase. Randomised controlled trials (RCTs) and observational studies published before 1 October 2020 will be included. Two reviewers in our team will conduct the study selection and data extraction independently. Risk of bias will be assessed by Cochrane Collaboration criteria and the Newcastle-Ottawa scale for RCTs and observational studies, respectively. We will assess the good functional outcomes defining the modified Rankin scale score ≤2 at 90 days after treatment, short-term stroke severity as National Institutes of Health Stroke Scale score at 24 hours after intervention, and successful recanalisation as a modified Thrombolysis in Cerebral Infarction scale score of ≥2b after intervention. Also, safety outcomes will be assessed. The performance of this meta-analysis will depend on the quantity of included studies. The assessment of study heterogeneity will be performed by the I2 statistic. If there is mild heterogeneity (I2<20%) of intervention outcomes in included studies, the fixed-effect model will be applied; otherwise, the random-effect model will be performed. Subgroup analyses and an assessment of publication bias will also be conducted with sufficient data.Ethics and disseminationNo collection of primary data from patients is needed. Therefore, the ethical approval is unnecessary. The results may be presented in a peer-reviewed journal and related conferences.PROSPERO registration numberCRD42020176764.

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Treatment of acute basilar artery occlusion: Systematic review and meta-analysis

Neurologia i Neurochirurgia Polska ◽

10.1016/j.pjnns.2017.07.012 ◽

2017 ◽

Vol 51 (6) ◽

pp. 486-496 ◽

Cited By ~ 12

Author(s):

Adam Wyszomirski ◽

Sebastian Szczyrba ◽

Dominika Tomaka ◽

Bartosz Karaszewski

Keyword(s):

Systematic Review ◽

Basilar Artery ◽

Meta Analysis ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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Therapy for acute basilar artery occlusion: a systematic review and meta-analysis

F1000Research ◽

10.12688/f1000research.18042.1 ◽

2019 ◽

Vol 8 ◽

pp. 165 ◽

Cited By ~ 9

Author(s):

Kevin Sheng ◽

Marcus Tong

Keyword(s):

Systematic Review ◽

Basilar Artery ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Significant Heterogeneity ◽

Aspiration Thrombectomy ◽

Endovascular Thrombectomy ◽

Treatment Methods

Purpose: This study aims to analyse the efficacy of different treatment methods for acute basilar artery occlusion, with an emphasis placed on evaluating the latest treatment methods. Method: A systematic review and meta-analysis was performed to analyse the current data on the therapies available for treating acute basilar artery occlusion. Results: A total of 102 articles were included. The weighted pooled rate of mortality was 43.16% (95% CI 38.35-48.03%) in the intravenous thrombolysis group, 45.56% (95% CI 39.88-51.28) in the intra-arterial thrombolysis group, and 31.40% (95% CI 28.31-34.56%) for the endovascular thrombectomy group. The weighted pooled rate of Modified Ranking Score (mRS) 0-2 at 3 months was 31.40 (95% CI 28.31-34.56%) in the IVT group, 28.29% (95% CI 23.16-33.69%) in the IAT group, and 35.22% (95% CI 32.39-38.09%) for the EVT group. Meta-analyses were also done for the secondary outcomes of recanalization and symptomatic haemorrhage. There was no difference between stent retriever and thrombo-aspiration thrombectomy on subgroup analysis in both clinical outcome and safety profile. Limitations: The included studies were observational in nature. There was significant heterogeneity in some of the outcomes. Conclusions: Superior outcomes and better recanalization rates for acute basilar occlusion were seen with patients managed with endovascular thrombectomy when compared with either intravenous and/or intraarterial thrombolysis. No superiority of stent‐retrievers over thrombo-aspiration thrombectomy was seen.

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