Background Mechanical thrombectomy (MT) is an effective treatment for patients with acute ischemic stroke (AIS) from basilar artery occlusion (BAO).
Objective To compare the clinical outcomes of MT, with and without bridging intravenous thrombolysis (IVT), in acute BAO through a systematic review and meta-analysis of the current literature.
Methods Systematic searches of Medline, EMBASE, and Cochrane Central were undertaken on August 1, 2022. Good functional outcome defined as 90-day modified Rankin Scale score 0–2 was the primary outcome measure. Secondary outcome measures were 90-day mortality, successful post-thrombectomy recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracranial hemorrhage (sICH), and subarachnoid hemorrhage (SAH).
Results Three studies reporting 1096 patients with BAO AIS were included in the meta-analysis. No significant differences in good functional outcome were detected between the two groups (RR=1.28 (95% CI 0.86 to 1.92); p=0.117). However, specifically patients with large artery atherosclerosis (LAA) benefited from bridging IVT (OR=2.52 (95% CI 1.51 to 4.22); p<0.001) with better functional outcomes. There was a significantly lower 90-day mortality rate for patients who underwent bridging IVT compared with MT alone (RR=0.70 (95% CI 0.62 to 0.80); p=0.008). No significant differences were detected in rates of post-treatment recanalization (RR=1.01 (95% CI 0.35 to 2.91); p=0.954), sICH (RR=0.96 (95% CI 0.66 to 1.42); p=0.724), and SAH (RR=0.93 (95% CI 0.31 to 2.83); p=0.563).
Conclusions In patients with AIS due to BAO, bridging IVT was associated with lower mortality rates at 90 days, compared with direct MT. There were no improved functional outcomes or increased sICH or SAH between both arms, However, patients with LAA benefited from bridging IVT, with better functional outcomes.
Data availability statement
Data are available upon reasonable request.
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Contributors KSL: conceptualization, methodology, investigation, acquisition of data, data analysis, software, writing – original draft, writing – review & editing, visualization, approval of manuscript, guarantor of the study. IS: acquisition of data, writing – review and editing, approval of manuscript. JJYZ, NLS, CSG, LZHY, GA, CY, BPLC, VKS, H-LT, JM, KSHT, MZM, PB, LM, SS, C-HS, AM, VM, TA, FA, VKG, T-HL: writing – review and editing, approval of manuscript. BYQT: methodology, writing – review and editing, approval of manuscript. LLLY: conceptualization, methodology, writing – review and editing, approval of manuscript, guarantor of the study.
Funding This research was sponsored by the National Medical Research Council (NMRC), Singapore. NMRC/MOH-TA19Nov-0003.
Competing interests GA: Stryker Neurovascular, Penumbra Inc, Medtronic: payments were received by the employer for consulting and proctoring assignments.
Provenance and peer review Not commissioned; externally peer reviewed.
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