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Original research
Firstline a direct aspiration first pass technique versus firstline stent retriever for acute basilar artery occlusion: a systematic review and meta-analysis
  1. Gengfan Ye1,2,
  2. Jun Lu1,
  3. Peng Qi1,
  4. Xiaoliang Yin1,2,
  5. Lijun Wang1,
  6. Daming Wang1,2
  1. 1 Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
  2. 2 Graduate School of Peking Union Medical College, Beijing, China
  1. Correspondence to Dr Daming Wang, National Center of Gerontology, Beijing Hospital, Beijing 100730, China; bjyyswwdm{at}


Introduction Acute basilar artery occlusion (BAO) can result in extremely high disability and mortality. Stent retrievers (SRs) can achieve a high recanalization rate for BAO, therefore improving favorable outcomes. However, the efficacy of a direct aspiration first pass technique (ADAPT) to treat BAO is unclear. Our aim was to compare the efficacy and safety of firstline ADAPT with that of firstline SR for patients with acute BAO.

Methods Three databases were systematically searched for literature reporting outcomes on thrombectomy for acute BAO with both firstline ADAPT and firstline SR. The modified Newcastle–Ottawa scale was applied to assess bias risk. The random effects model was used.

Results Of 50 articles, 5 cohort studies (2 prospective and 3 retrospective) were included in our research. 193 cases were treated with firstline ADAPT and 283 cases received firstline SR. Successful recanalization rate was significantly higher in the firstline ADAPT group (OR=2.0, 95% CI 1.1 to 3.5). Procedure time (mean difference=−27.6 min, 95% CI −51.0 to −4.3) and the incidence of new territory embolic event (OR=0.2, 95% CI 0.05 to 0.83) was significantly less in the firstline ADAPT group. No significant difference was observed between the firstline ADAPT and firstline SR groups for rate of complete recanalization, rescue therapy, any hemorrhagic complication, favorable outcomes, or mortality at 90 days.

Conclusions Our meta-analysis suggested that for patients with acute BAO, firstline ADAPT might achieve higher and faster recanalization, comparable neurological improvement and safety compared with firstline SR. Further studies are needed to confirm these results.

  • thrombectomy
  • stroke

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  • Contributors GY designed the study, performed the literature search and selection, extracted and analyzed the data, and wrote and revised the manuscript. JL performed the literature search and selection, extracted the data, and revised the manuscript. PQ performed the literature search and selection, and revised the manuscript. XY and LW analyzed the data and revised the manuscript. DW designed the study, monitored the study inclusion and data extraction, and revised the manuscript. He is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are available in the manuscript.