Endovascular thrombectomy with or without intravenous thrombolysis in acute basilar artery occlusion ischemic stroke: A meta-analysis |
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| Institution: | 1. Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY;2. Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY;1. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA;2. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA;3. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA;1. Tufts University School of Medicine, 145 Harrison Ave. Boston, M.A., 02111;2. Department of Neurosurgery, Tufts Medical Center, 300 Washington Ave., Boston, M.A., 02111;3. Department of Cardiology, Tufts Medical Center, 300 Washington Ave., Boston, M.A., 02111;1. Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan;2. Siemens Healthcare K.K., Tokyo, Japan;3. Department of Radiology, The Jikei University Hospital, Tokyo, Japan;1. Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1101, Japan;2. Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan;3. Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan;4. Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan;5. Department of Neurosurgery, Fujita Health University School of Medicine, Aichi, Japan |
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| Abstract: | IntroductionIt is poorly understood if endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) better facilitates clinical outcomes in patients with acute basilar artery occlusion (BAO) ischemic stroke.MethodsA systematic literature review and meta-analysis was completed to investigate the outcomes of EVT with IVT versus direct EVT alone in acute BAO. Data was collected from the literature and pooled with the authors’ institutional experience. The primary outcome measure was 90-day modified Rankin sale (mRS) of 0-2. Secondary measures were successful post-thrombectomy recanalization defined as mTICI ≥2b, 90-day mortality, and rate of symptomatic ICH.ResultsOur institutional experience combined with three multicenter studies resulted in a total of 1,127 patients included in the meta-analysis. 756 patients underwent EVT alone, while 371 were treated with EVT+IVT. Patients receiving EVT+IVT had a higher odds of achieving a 90-day mRS of ≤ 2 compared to EVT alone (OR: 1.50, 95% CI 1.15 to 1.95, P =0.002, I2 =0%). EVT+IVT also had a lower odds of 90-day mortality (OR: 0.57, 95% CI 0.37 to 0.89, P=0.01, I2=24%). There was no difference in sICH between the two groups (OR: 1.0, 95% CI: 0.56 to 1.79, P=0.99, I2=0%). There was also no difference in post-thrombectomy recanalization rates defined as mTICI ≥2b (OR: 1.11, 95% CI 0.70 to 1.75, P = 0.65, I2=37%).ConclusionsOn meta-analysis, EVT with bridging IVT results in superior 90-day functional outcomes and lower 90-day mortality without increase in symptomatic ICH. These findings likely deserve further validation in a randomized controlled setting. |
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