Abstract Number ‐ 193: Endovascular Thrombectomy for Basilar Artery Occlusion: Systematic Review and Meta‐analysis

Abstract

Introduction Basilar artery occlusion (BAO), accounting for approximately 1% of all ischemic strokes and 5–10% of all proximal intracranial occlusions, usually causes devastating neurologic sequelae, poor prognosis and even death [1‐2]. Endovascular thrombectomy (EVT) has been recommended for anterior circulation stroke with large vessel occlusion (LVO) [3‐6]. During the past decade, there has been emerging interests in whether EVT could provide similar overwhelming benefits in posterior circulation stroke, especially BAO [7‐8]. The goal of our study is to compare EVT with conservative medical treatment (CMT) about the efficacy and the safety in patients with BAO. Methods All relevant literature comparing the outcomes of EVT versus CMT in patients with BAO were recruited via PubMed, Embase and the Cochrane Library until April 2022. Random‐effects model was adopted to pool estimates regrading favorable/good functional outcome, symptomatic intracranial hemorrhage (sICH) and the mortality. The heterogeneity of outcomes was assessed using the Cochran Q test (reported as a Cochran Q p value) and I2 statistics. Results Of the eight studies, a total of 3733 patients with pure BAO were enrolled. EVT was conducted in 2573 patients, and the others received CMT. Compared with CMT group, EVT group with or without intravenous thrombolytic therapy achieved more favorable functional outcome (OR 1.26, 95% CI 1.03 to 1.55, I2 = 54%, p = 0.05; Figure 1A) in patients with BAO. Similar trend was also noted in the good functional outcome (OR 1.23, 95% CI 0.97 to 1.57, I2 = 63%, p = 0.02; Figure 1B). Even though EVT group tended to provoke more sICH (OR 2.91, 95% CI 1.38 to 6.18, I2 = 22%, p = 0.27; Figure 1C), it reduced the mortality (OR 0.81, 95% CI 0.70 to 0.93, I2 = 31%, p = 0.19; Figure 1D) in patients with BAO, originally a devastating condition. Conclusions Our study worked in concert with the recent climate in the endovascular era [9] that EVT in BAO provides superior functional outcomes and less mortality compared with CMT. Despite the tendency of developing sICH after reperfusion, EVT still brought a dawn to posterior circulation stroke. We are no more at our wits’ end with BAO and its grave prognosis. Furthermore, we still need more future randomized control trials [10] or large‐scale cohorts for conclusive evidence.