Endovascular Treatment for Basilar Artery Occlusion: A Systematic Review and Meta-analysis

Aristeidis H Katsanos, Apostolos Safouris, Stavros Nikolakopoulos, Dimitris Mavridis, Nitin Goyal, Marios N Psychogios, Georgios Magoufis, Christos Krogias, Luciana Catanese, Brian Van Adel, Guy Raphaeli, Amrou Sarraj, Marios Themistocleous, Evangelia Kararizou, Guillaume Turc, Adam Arthur, Andrei V Alexandrov, Georgios Tsivgoulis
European Journal of Neurology 2021 January 22

BACKGROUND AND PURPOSE: Independent randomized-controlled clinical trials (RCTs) provided robust evidence for endovascular treatment (EVT) as the standard of care treatment for acute large vessel occlusions in the anterior circulation. We examined available studies specific to posterior cerebral circulation ischemic strokes to see if any conclusions can be drawn regarding endovascular treatment options.

METHODS: We performed a systematic literature search to identify studies evaluating the safety and efficacy of EVT versus standard medical treatment for patients with acute basilar artery occlusion (BAO). We extracted data for outcomes of interest and presented associations between the two groups with the use of risk (RR) or odds ratios (ORs), with corresponding 95% confidence intervals (95%CIs). We used a random-effects model to pool the effect estimates.

RESULTS: We identified a total of 5 studies (two RCTs, three observational cohorts) including a total of 1098 patients. Patients receiving EVT had higher risk of symptomatic intracranial hemorrhage (sICH) compared to those receiving non-interventional medical management (RR= 5.42, 95%CI: 2.74-10.71). Non-significant trends towards better mRS 0-2 (RR= 1.02, 95%CI: 0.74-1.41), mRS 0-3 (RR= 0.97, 95%CI: 0.64-1.47) scores, overall functional improvement (OR=1 0.93, 95%CI: 0.57-1.51) and all-cause mortality (RR= 1.03, 95%CI: 0.78-1.35) at three months were seen.

CONCLUSION: Although endovascular therapy increases the probability of sICH, available data do not exclude the possibility of improved functional outcomes over standard therapy. As larger studies are challenged by the perceived lack of equipoise in this vulnerable patient population, results of ongoing RCTs are expected to provide substantial input for future meta-analyses.

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