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Outcomes of endovascular treatment of basilar artery occlusion in the stent retriever era: a systematic review and meta-analysis
  1. Kevin Phan1,2,3,
  2. Steven Phan1,3,
  3. Ya Ruth Huo2,
  4. Fangzhi Jia1,3,
  5. Alex Mortimer4
  1. 1NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia
  2. 2Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia
  3. 3Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
  4. 4Department of Neuroradiology, North Bristol NHS Trust, Bristol, UK
  1. Correspondence to Dr Kevin Phan, NeuroSpine Surgery Research Group (NSURG), Level 7, Prince of Wales Private Hospital, Barker Street, Randwick, NSW 2109, Australia; kphan.vc{at}gmail.com

Abstract

Background Stent retriever thrombectomy has recently been found to be effective for anterior circulation strokes, but its efficacy for basilar artery occlusion (BAO) is unclear.

Objective To carry out a systematic review and meta-analysis to analyze the available evidence for the use of stent retrievers for BAO.

Methods Two independent reviewers searched six databases for studies reporting outcomes following endovascular treatment for BAO.

Results A total of 17 articles (6 prospective and 11 retrospective) were included. The weighted mean age of patients was 67 years (range 59–82) and 59% were male. Thrombolytic drugs were administered intravenously and intra-arterially in 46% (range 0–88%) and 38% (range 0–90%) of patients, respectively. Weighted pooled estimates of successful recanalization (TICI 2b–3) and good outcome (modified Rankin Scale ≤2) were 80.0% (95% CI 70.7% to 88.0%; I2=80.28%; p<0.001) and 42.8% (95% CI 34.0% to 51.8%; I2=61.83%; p=0.002), respectively. Pooled mortality was 29.4% (95% CI 23.9% to 35.3%; I2=37.01%; p=0.087). Incidence of procedure-related complications and symptomatic hemorrhage was 10.0% (95% CI 3.7% to 18.3%; I2=61.05%; p=0.017) and 6.8% (95% CI 3.5% to 10.8%; I2=37.99%; p=0.08), respectively.

Conclusions Stent retriever thrombectomy achieves a high rate of recanalization and functional independence while being relatively safe for patients with BAO. Future prospective studies with long-term follow-up are warranted.

  • Thrombectomy
  • Thrombolysis
  • Device
  • Stent
  • Stroke

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