Abstract
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.
Highlights
Strokes caused by basilar artery occlusion are uncommon, with around 10% of large vessel strokes being basilar[1]
This systematic review and meta-analysis shows better mortality, good clinical outcome and recanalization rates for acute basilar occlusion patients managed with endovascular thrombectomy when compared with either intravenous and/or intraarterial thrombolysis
In conclusion, the above data supports superior outcomes and better recanalization rates for acute basilar occlusion patients managed with endovascular thrombectomy when compared with either intravenous and/or intraarterial thrombolysis
Summary
Strokes caused by basilar artery occlusion are uncommon, with around 10% of large vessel strokes being basilar[1] They are associated with very poor outcomes and high mortality; the condition can be heterogenous with variable prognosis[2]. Pertinent clinical profiles pertaining to the topic and the discussion include: 1) proximal and middle basilar artery occlusive disease, frequently of atherosclerotic origin accounting for unilateral or bilateral pontine dysfunction, and less often cerebellar, midbrain, occipital, or mesial temporal lobe ischemia; 2) distal basilar artery occlusion ("top of the basilar syndrome"), frequently of embolic origin and accounting for signs of midbrain and thalamic ischemia, occipital and mesial temporal lobe ischemia, or both. The authors performed a systematic review and meta-analysis comparing three methods of recanalization for acute basilar artery occlusion. Questions and Comments: Title: ○ Identified as a systematic review and meta-analysis
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