Endovascular Treatment versus Medical Treatment for Basilar Artery Occlusion: A Systematic Review and Meta-Analysis
Hamilton Roberto Moreira de Oliveira Carrico1, Nuris Torres Argota2, Helen Beckert3, Larissa Tanimoto4, Andressa Cardoso5, Francisco Jose Germano Hennemann6, Paulo Cruz7, Artur Menegaz de Almeida8
1University of Southern Santa Catarina, 2Santa Casa de Misericórdia Hospital in Porto Alegre, 3Federal University of Paraná, 4University of Buenos Aires, 5Nove de Julho University, 6Taubaté University, 7Federal University of Pará, 8Federal University of Mato Grosso
Objective:
This systematic review and meta-analysis aims to compare the efficacy and safety of ET versus SMT in BAO patients, assessing their impact on clinical outcomes.
Background:
Basilar artery occlusion (BAO) is a severe type of stroke associated with high mortality and poor neurological outcomes. Despite advancements in endovascular treatment (ET), its superiority over standard medical therapy (SMT) remains uncertain.
Design/Methods:
We conducted systematic searches in PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) comparing ET and SMT in BAO patients. The selected outcomes were mortality, successful reperfusion, and neurological outcomes at 90 days. Pooled analyses used fixed effects models, calculating 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R software, version 4.4.1.
Results:
Eight studies met the inclusion criteria, with 1,200 patients in the endovascular treatment group and 555 in the SMT control group. The analysis demonstrated a significant reduction in mortality with ET compared to SMT (0% vs. 44%; OR 0.44; 95% CI (0.30 to 0.65); P < 0.0001). Secondary outcomes also favored ET, showing higher successful reperfusion rates (OR = 3.36, 95% CI [1.98; 5.70], P < 0.01) and better neurological outcomes at 90 days (OR = 1.54, 95% CI [1.10; 2.17], P < 0.05).
Conclusions:
This meta-analysis demonstrates that ET offers significant advantages over SMT for patients with BAO, leading to lower mortality and better neurological outcomes. Given this evidence, ET could be considered a preferred treatment option. Further research is needed to understand long-term effects and manage potential complications.
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