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

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.