Efficacy and Safety of Endovascular Thrombectomy with or without Thrombolysis in Acute Basilar Artery Occlusion: A Meta-analysis of Randomized and Non-Randomized Studies
Muhammad Khan1, Hassan Waseem2, Zain abideen3, Rowaid Ahmad4, Muhammad Ansari4, Sania Aimen5
1Saidu Medical College, Swat, Pakistan, 2Allama Iqbal Medical College, Lahore, Pakistan, 3King Edward Medical University, Lahore, Pakistan, 4University of Texas Medical Branch Galveston Texas, 5Quetta Institute of Medical Sciences, Pakistan
Objective:

To compare the efficacy and safety of endovascular thrombectomy (EVT) combined with intravenous thrombolysis (IVT) as bridging therapy versus EVT alone in patients with acute basilar artery occlusion (BAO).

Background:

BAO represents a serious medical condition associated with significant morbidity and mortality risks. EVT has emerged as the primary approach; however, the application of IVT alongside these techniques continues to be a subject of debate. Prior research on combining these two interventions as a bridging therapy has yielded conflicting results.

Design/Methods:

PubMed, Cochrane Central, and Embase were searched up to September 2024. Risk ratios (RR) and Mean Difference (MD) along with 95% Confidence Intervals (CI) were pooled for dichotomous and continuous outcomes respectively, using the Review Manager 5.4.1. The primary outcome was functional independence (Rankin modified scale [mRS] ≤2). The quality of the included studies was assessed through NOS and RoB 2.0 tools.

Results:

This meta-analysis included 3,685 patients from 3 RCTs and 11 Cohort studies. Patients undergoing EVT plus IVT (bridging therapy) exhibited a significantly increased Functional Independence (mRS ≤2) (RR = 1.27; 95% CI: [1.13–1.43]; p < 0.0001; I2= 23%) and Independent Ambulation (mRS ≤3) (RR = 1.10; 95% CI: [1.01–1.20]; p = 0.02; I2= 0%) along with decreased mortality (RR = 0.83; 95% CI:[0.75–0.93]; p = 0.001; I2= 0%) compared to those receiving EVT alone. No significant difference was observed in the risk of symptomatic intracerebral hemorrhage (sICH) (RR = 0.99; 95% CI: [0.71–1.39]; p = 0.97; I2= 0%) and Successful Recanalization rates (RR = 1.00; 95% CI: [0.97–1.03]; p = 0.99; I2= 0%).

Conclusions:

The combination of EVT and IVT significantly improves functional outcomes and mortality without increasing sICH risk or recanalization rates in patients with acute BAO. Validating these findings and studying long-term impact requires further research.

10.1212/WNL.0000000000212006
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