High-quality evidence regarding the use of endovascular treatment (EVT) in patients
with acute basilar artery occlusion (BAO) has been provided by recently completed
randomized controlled clinical trials (RCTs).We conducted a systematic review and
meta-analysis including all available RCTs that investigated efficacy and safety of
EVT in addition to best medical treatment (BMT) versus BMT alone for BAO. The random-effects
model was used, while the fragility index (FI) was calculated for dichotomous outcomes
of interest.Four RCTs were included comprising a total of 988 patients with acute
BAO (mean age: 65.6 years, 70% men, median NIHSS: 24, 39% pretreatment with intravenous
thrombolysis). EVT was related to higher likelihood of good functional outcome (RR:
1.54; 95% CI: 1.16-2.05; I2 = 60%), functional independence (RR: 1.83; 95% CI: 1.08-3.08;
I2 = 79%) and reduced disability at 3 months (adjusted common OR: 1.96; 95% CI: 1.26-3.05;
I2 = 59%) compared to BMT alone. Despite that EVT was associated with a higher risk
for symptomatic intracranial hemorrhage (RR: 7.78; 95% CI: 2.36-25.61; I2 = 0%) and
any intracranial hemorrhage (RR: 2.85; 95% CI: 1.50-5.44; I2 = 16%), mortality at
3 months was lower among patients that received EVT plus BMT versus BMT alone (RR:
0.76; 95% CI: 0.65-0.89; I2 = 0%). However, sufficient robustness was not evident
in any of the reported associations (FI < 10) including the overall effect regarding
the primary outcome. The former associations were predominantly driven by RCTs with
recruitment limited in China.EVT combined with BMT is associated with a higher likelihood
of achieving good functional outcomes and a lower risk of death at 3 months compared
to BMT alone, despite the higher risk of sICH. An individual-patient data meta-analysis
is warranted to uncover and adjust for potential sources of heterogeneity and to provide
further insight.
