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Endovascular treatment for basilar artery occlusion: A systematic review and meta‐analysis
Author(s) -
Katsanos Aristeidis H.,
Safouris Apostolos,
Nikolakopoulos Stavros,
Mavridis Dimitris,
Goyal Nitin,
Psychogios Marios N.,
Magoufis Georgios,
Krogias Christos,
Catanese Luciana,
Van Adel Brian,
Raphaeli Guy,
Sarraj Amrou,
Themistocleous Marios,
Kararizou Evangelia,
Turc Guillaume,
Arthur Adam,
Alexandrov Andrei V.,
Tsivgoulis Georgios
Publication year - 2021
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.14751
Subject(s) - medicine , confidence interval , meta analysis , odds ratio , modified rankin scale , randomized controlled trial , observational study , relative risk , basilar artery , occlusion , cardiology , ischemic stroke , ischemia
Abstract Background and purpose Independent randomized controlled clinical trials (RCTs) have 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 EVT 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 ratios (RRs) or odds ratios (ORs), with corresponding 95% confidence intervals (CIs). We used a random‐effects model to pool the effect estimates. Results We identified five studies (two RCTs, three observational cohorts) including a total of 1098 patients. Patients receiving EVT had a higher risk of symptomatic intracranial hemorrhage (sICH) compared to those receiving non‐interventional medical management (RR 5.42, 95% CI 2.74–10.71). Nonsignificant trends towards modified Rankin Scale (mRS) scores 0–2 (RR 1.02, 95% CI 0.74–1.41), mRS scores 0–3 (RR = 0.97, 95% CI 0.64–1.47), overall functional improvement (OR 0.93, 95% CI 0.57–1.51), and all‐cause mortality (RR 1.03, 95% CI 0.78–1.35) at 3 months were seen. Conclusion Although EVT increases the probability of sICH, the 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.