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. 2023 Nov 28;9(12):e22953.
doi: 10.1016/j.heliyon.2023.e22953. eCollection 2023 Dec.

Endovascular thrombectomy for basilar-artery occlusion: A meta-analysis with trial sequential analysis

Wei-Sheng Wang  1   2 , Yu-Ping Chiu  1   3 , Po-Huang Chen  4 , Hong-Jie Jhou  1   5
Affiliations

Endovascular thrombectomy for basilar-artery occlusion: A meta-analysis with trial sequential analysis

Wei-Sheng Wang et al. Heliyon. .

Abstract

Background and purpose: Basilar-artery occlusion (BAO) usually accounts for devastating neurologic sequelae, poor prognosis, and even death. While endovascular thrombectomy (EVT) is the most successful treatment for anterior circulation stroke with large vessel occlusion, its effectiveness in treating acute BAO is still debatable. Our aim is to compare the efficacy and safety between EVT and conservative medical treatment (CMT) in BAO.

Methods: Up until May 2022, relevant literature was gathered using searches in Embase, PubMed, and the Cochrane Library. The primary outcomes were defined as good functional outcome (modified Rankin Scale 0-2) and favorable functional outcome (modified Rankin Scale 0-3) at 3 months between EVT and CMT groups. The secondary outcomes included mortality at 3 months, symptomatic intracerebral hemorrhage (ICH), and any ICH.

Results: Eight studies involving 3733 patients with BAO were enrolled 2573 individuals underwent EVT, and the remaining 1160 patients received CMT. Compared with CMT, EVT achieved more favorable functional outcome (odds ratio (OR) 1.26, 95% CI 1.03-1.55, I2 = 54%, p = 0.05) in BAO. The good functional outcome showed a similar tendency (OR 1.23, 95% CI 0.97-1.57, I2 = 63%, p = 0.02) as well. EVT decreased mortality at 3 months (OR 0.81, 95% CI 0.70-0.93, I2 = 31 %, p = 0.19), although having a tendency to cause symptomatic ICH (OR 2.91, 95% CI 1.38-6.18, I2 = 22 %, p = 0.27).

Conclusions: EVT in BAO provides superior functional outcomes and less mortality compared with CMT. Even though EVT has the propensity to cause symptomatic ICH, EVT nevertheless improved posterior circulation stroke.

Keywords: Acute ischemic stroke; Basilar-artery occlusion; Endovascular thrombectomy; Meta-analysis.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This study was supported by the Tri-Service General Hospital/National Defense Medical Center (No. TSGH-D-112157).

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Flowchart of the selection process for eligible studies.
Fig. 2
Fig. 2
Meta-analysis of outcomes among patients with basilar-artery occlusion secondary to endovascular therapy. (A) Good functional outcome, (B) favorable functional outcome, (C) mortality at 3 months, (D) symptomatic intracerebral hemorrhage.
Fig. 3
Fig. 3
Trial sequential analysis of outcomes. (A) Good functional outcome, (B) favorable functional outcome, (C) mortality at 3 months, (D) symptomatic intracerebral hemorrhage. We take the number of patients on the x-axis and the cumulative Z-score. The conventional boundaries are indicated using the horizontal green line. The trial sequential monitoring boundaries are shown using the sloping red line at the top left-hand corners and represent the TSA threshold for statistical significance. The required information size (RIS) is shown using the vertical red full line. The cumulative Z-curve is shown using the solid blue line. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
See this image and copyright information in PMC

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