Endovascular versus Medical Management of Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of the Randomized Controlled Trials

Background and Purpose The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared to medical management (MM) for acute BAO through a meta-analysis of randomized controlled trials...

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Vydané v:	Journal of stroke Ročník 25; číslo 1; s. 81 - 91
Hlavní autori:	Abdalkader, Mohamad, Finitsis, Stephanos, Li, Chuanhui, Hu, Wei, Liu, Xinfeng, Ji, Xunming, Huo, Xiaochuan, Alemseged, Fana, Qiu, Zhongming, Strbian, Daniel, Puetz, Volker, Siegler, James E., Yaghi, Shadi, Asif, Kaiz, Klein, Piers, Zhu, Yuyou, Campbell, Bruce C.V., Chen, Hui-Sheng, Nagel, Simon, Tsivgoulis, Georgios, Miao, Zhongrong, Nogueira, Raul G., Jovin, Tudor G., Schonewille, Wouter J., Nguyen, Thanh N.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	Korea (South) Korean Stroke Society 01.01.2023 대한뇌졸중학회
Predmet:	acute basilar artery occlusion acute stroke meta-analysis posterior circulation Review 신경과학 Posterior circulation Acute basilar artery occlusion Acute stroke Meta-analysis
ISSN:	2287-6391, 2287-6405
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Abstract	Background and Purpose The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared to medical management (MM) for acute BAO through a meta-analysis of randomized controlled trials (RCTs).Methods We performed a systematic review and meta-analysis of RCTs of patients with acute BAO. We analyzed the pooled effect of EVT compared to MM on the primary outcome (modified Rankin Scale [mRS] of 0–3 at 3 months), secondary outcome (mRS 0–2 at 3 months), symptomatic intracranial hemorrhage (sICH), and 3-month mortality rates. For each study, effect sizes were computed as odds ratios (ORs) with random effects and Mantel-Haenszel weighting.Results Four RCTs met inclusion criteria including 988 patients. There were higher odds of mRS of 0-3 at 90 days in the EVT versus MM group (45.1% vs. 29.1%, OR 1.99, 95% confidence interval [CI] 1.04–3.80; P=0.04). Patients receiving EVT had a higher sICH compared to MM (5.4% vs. 0.8%, OR 7.89, 95% CI 4.10–15.19; P<0.01). Mortality was lower in the EVT group (35.5% vs. 45.1%, OR 0.64, 95% CI 0.42–0.99; P=0.05). In an analysis of two trials with BAO patients and National Institutes of Health Stroke Scale (NIHSS) <10, there was no difference in 90-day outcomes between EVT versus MM.Conclusion In this systematic review and meta-analysis, EVT was associated with favorable outcome and decreased mortality in patients with BAO up to 24 hours from stroke symptoms compared to MM. The treatment effect in BAO patients with NIHSS <10 was less certain. Further studies are of interest to evaluate the efficacy of EVT in basilar occlusion patients with milder symptoms.
AbstractList	Background and Purpose The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared to medical management (MM) for acute BAO through a meta-analysis of randomized controlled trials (RCTs).Methods We performed a systematic review and meta-analysis of RCTs of patients with acute BAO. We analyzed the pooled effect of EVT compared to MM on the primary outcome (modified Rankin Scale [mRS] of 0–3 at 3 months), secondary outcome (mRS 0–2 at 3 months), symptomatic intracranial hemorrhage (sICH), and 3-month mortality rates. For each study, effect sizes were computed as odds ratios (ORs) with random effects and Mantel-Haenszel weighting.Results Four RCTs met inclusion criteria including 988 patients. There were higher odds of mRS of 0-3 at 90 days in the EVT versus MM group (45.1% vs. 29.1%, OR 1.99, 95% confidence interval [CI] 1.04–3.80; P=0.04). Patients receiving EVT had a higher sICH compared to MM (5.4% vs. 0.8%, OR 7.89, 95% CI 4.10–15.19; P<0.01). Mortality was lower in the EVT group (35.5% vs. 45.1%, OR 0.64, 95% CI 0.42–0.99; P=0.05). In an analysis of two trials with BAO patients and National Institutes of Health Stroke Scale (NIHSS) <10, there was no difference in 90-day outcomes between EVT versus MM.Conclusion In this systematic review and meta-analysis, EVT was associated with favorable outcome and decreased mortality in patients with BAO up to 24 hours from stroke symptoms compared to MM. The treatment effect in BAO patients with NIHSS <10 was less certain. Further studies are of interest to evaluate the efficacy of EVT in basilar occlusion patients with milder symptoms. The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared to medical management (MM) for acute BAO through a meta-analysis of randomized controlled trials (RCTs).BACKGROUND AND PURPOSEThe optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared to medical management (MM) for acute BAO through a meta-analysis of randomized controlled trials (RCTs).We performed a systematic review and meta-analysis of RCTs of patients with acute BAO. We analyzed the pooled effect of EVT compared to MM on the primary outcome (modified Rankin Scale [mRS] of 0-3 at 3 months), secondary outcome (mRS 0-2 at 3 months), symptomatic intracranial hemorrhage (sICH), and 3-month mortality rates. For each study, effect sizes were computed as odds ratios (ORs) with random effects and Mantel-Haenszel weighting.METHODSWe performed a systematic review and meta-analysis of RCTs of patients with acute BAO. We analyzed the pooled effect of EVT compared to MM on the primary outcome (modified Rankin Scale [mRS] of 0-3 at 3 months), secondary outcome (mRS 0-2 at 3 months), symptomatic intracranial hemorrhage (sICH), and 3-month mortality rates. For each study, effect sizes were computed as odds ratios (ORs) with random effects and Mantel-Haenszel weighting.Four RCTs met inclusion criteria including 988 patients. There were higher odds of mRS of 0-3 at 90 days in the EVT versus MM group (45.1% vs. 29.1%, OR 1.99, 95% confidence interval [CI] 1.04-3.80; P=0.04). Patients receiving EVT had a higher sICH compared to MM (5.4% vs. 0.8%, OR 7.89, 95% CI 4.10-15.19; P<0.01). Mortality was lower in the EVT group (35.5% vs. 45.1%, OR 0.64, 95% CI 0.42-0.99; P=0.05). In an analysis of two trials with BAO patients and National Institutes of Health Stroke Scale (NIHSS) <10, there was no difference in 90-day outcomes between EVT versus MM.RESULTSFour RCTs met inclusion criteria including 988 patients. There were higher odds of mRS of 0-3 at 90 days in the EVT versus MM group (45.1% vs. 29.1%, OR 1.99, 95% confidence interval [CI] 1.04-3.80; P=0.04). Patients receiving EVT had a higher sICH compared to MM (5.4% vs. 0.8%, OR 7.89, 95% CI 4.10-15.19; P<0.01). Mortality was lower in the EVT group (35.5% vs. 45.1%, OR 0.64, 95% CI 0.42-0.99; P=0.05). In an analysis of two trials with BAO patients and National Institutes of Health Stroke Scale (NIHSS) <10, there was no difference in 90-day outcomes between EVT versus MM.In this systematic review and meta-analysis, EVT was associated with favorable outcome and decreased mortality in patients with BAO up to 24 hours from stroke symptoms compared to MM. The treatment effect in BAO patients with NIHSS <10 was less certain. Further studies are of interest to evaluate the efficacy of EVT in basilar occlusion patients with milder symptoms.CONCLUSIONIn this systematic review and meta-analysis, EVT was associated with favorable outcome and decreased mortality in patients with BAO up to 24 hours from stroke symptoms compared to MM. The treatment effect in BAO patients with NIHSS <10 was less certain. Further studies are of interest to evaluate the efficacy of EVT in basilar occlusion patients with milder symptoms. Background and Purpose The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared to medical management (MM) for acute BAO through a meta-analysis of randomized controlled trials (RCTs). Methods We performed a systematic review and meta-analysis of RCTs of patients with acute BAO. We analyzed the pooled effect of EVT compared to MM on the primary outcome (modified Rankin Scale [mRS] of 0–3 at 3 months), secondary outcome (mRS 0–2 at 3 months), symptomatic intracranial hemorrhage (sICH), and 3-month mortality rates. For each study, effect sizes were computed as odds ratios (ORs) with random effects and Mantel-Haenszel weighting. Results Four RCTs met inclusion criteria including 988 patients. There were higher odds of mRS of 0-3 at 90 days in the EVT versus MM group (45.1% vs. 29.1%, OR 1.99, 95% confidence interval [CI] 1.04–3.80; P=0.04). Patients receiving EVT had a higher sICH compared to MM (5.4% vs. 0.8%, OR 7.89, 95% CI 4.10–15.19; P<0.01). Mortality was lower in the EVT group (35.5% vs. 45.1%, OR 0.64, 95% CI 0.42–0.99; P=0.05). In an analysis of two trials with BAO patients and National Institutes of Health Stroke Scale (NIHSS) <10, there was no difference in 90-day outcomes between EVT versus MM. Conclusion In this systematic review and meta-analysis, EVT was associated with favorable outcome and decreased mortality in patients with BAO up to 24 hours from stroke symptoms compared to MM. The treatment effect in BAO patients with NIHSS <10 was less certain. Further studies are of interest to evaluate the efficacy of EVT in basilar occlusion patients with milder symptoms. KCI Citation Count: 0 The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared to medical management (MM) for acute BAO through a meta-analysis of randomized controlled trials (RCTs). We performed a systematic review and meta-analysis of RCTs of patients with acute BAO. We analyzed the pooled effect of EVT compared to MM on the primary outcome (modified Rankin Scale [mRS] of 0-3 at 3 months), secondary outcome (mRS 0-2 at 3 months), symptomatic intracranial hemorrhage (sICH), and 3-month mortality rates. For each study, effect sizes were computed as odds ratios (ORs) with random effects and Mantel-Haenszel weighting. Four RCTs met inclusion criteria including 988 patients. There were higher odds of mRS of 0-3 at 90 days in the EVT versus MM group (45.1% vs. 29.1%, OR 1.99, 95% confidence interval [CI] 1.04-3.80; P=0.04). Patients receiving EVT had a higher sICH compared to MM (5.4% vs. 0.8%, OR 7.89, 95% CI 4.10-15.19; P<0.01). Mortality was lower in the EVT group (35.5% vs. 45.1%, OR 0.64, 95% CI 0.42-0.99; P=0.05). In an analysis of two trials with BAO patients and National Institutes of Health Stroke Scale (NIHSS) <10, there was no difference in 90-day outcomes between EVT versus MM. In this systematic review and meta-analysis, EVT was associated with favorable outcome and decreased mortality in patients with BAO up to 24 hours from stroke symptoms compared to MM. The treatment effect in BAO patients with NIHSS <10 was less certain. Further studies are of interest to evaluate the efficacy of EVT in basilar occlusion patients with milder symptoms.
Author	Nogueira, Raul G. Nguyen, Thanh N. Li, Chuanhui Puetz, Volker Yaghi, Shadi Finitsis, Stephanos Qiu, Zhongming Siegler, James E. Hu, Wei Campbell, Bruce C.V. Liu, Xinfeng Huo, Xiaochuan Chen, Hui-Sheng Miao, Zhongrong Ji, Xunming Nagel, Simon Abdalkader, Mohamad Schonewille, Wouter J. Klein, Piers Strbian, Daniel Jovin, Tudor G. Alemseged, Fana Zhu, Yuyou Asif, Kaiz Tsivgoulis, Georgios
AuthorAffiliation	Departments of Radiology and Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
AuthorAffiliation_xml	– name: Departments of Radiology and Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/36746382$$D View this record in MEDLINE/PubMed https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002927685$$DAccess content in National Research Foundation of Korea (NRF)
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Copyright	Copyright © 2023 Korean Stroke Society 2023
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References_xml	– ident: ref11 doi: 10.1016/j.jstrokecerebrovasdis.2022.106804 – ident: ref12 doi: 10.1016/s1474-4422(09)70173-5 – start-page: 11 volume-title: Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct year: 2018 ident: ref6 – ident: ref9 doi: 10.1016/j.neurad.2017.01.126 – start-page: e400 volume-title: Thrombectomy for basilar artery occlusion with mild symptoms year: 2021 ident: ref37 – ident: ref21 doi: 10.7326/0003-4819-151-4-200908180-00135 – ident: ref26 doi: 10.1161/strokeaha.114.004884 – ident: ref10 doi: 10.1161/svin.122.000538 – ident: ref16 doi: 10.1007/s12975-022-01008-5 – ident: ref25 doi: 10.1161/strokeaha.121.035948 – ident: ref30 doi: 10.1161/strokeaha.122.040807 – ident: ref32 doi: 10.5853/jos.2020.01788 – ident: ref5 doi: 10.1056/nejmoa1415061 – ident: ref17 doi: 10.1016/j.jemermed.2021.06.003 – ident: ref34 doi: 10.1016/j.neurad.2022.12.004 – ident: ref14 doi: 10.1161/circulationaha.121.058544 – ident: ref40 doi: 10.1212/wnl.0000000000200030 – ident: ref42 doi: 10.1136/bmj.n71 – ident: ref8 doi: 10.1016/s1474-4422(16)30177-6 – ident: ref20 doi: 10.1056/nejmoa2207576 – ident: ref2 doi: 10.1056/nejmoa1414792 – ident: ref41 doi: 10.1161/SVIN.122.000642 – ident: ref22 doi: 10.1186/1471-2288-14-25 – ident: ref28 doi: 10.1016/s0140-6736(16)00163-x – ident: ref24 doi: 10.1056/nejmoa1214300 – ident: ref23 doi: 10.1159/000086121 – ident: ref4 doi: 10.1056/nejmoa1503780 – ident: ref33 doi: 10.1159/000108174 – ident: ref39 doi: 10.1186/s12883-019-1551-8 – ident: ref3 doi: 10.1056/nejmoa1414905 – ident: ref38 doi: 10.1111/ene.14751 – ident: ref13 doi: 10.1016/j.jstrokecerebrovasdis.2017.04.043 – ident: ref31 doi: 10.1002/ana.23904 – ident: ref35 doi: 10.1161/strokeaha.120.034019 – ident: ref36 doi: 10.1161/strokeaha.118.021106 – start-page: 11 volume-title: A randomized trial of intraarterial treatment for acute ischemic stroke year: 2015 ident: ref1 – start-page: 115 volume-title: Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial year: 2020 ident: ref18 – ident: ref7 doi: 10.1056/nejmoa1713973 – ident: ref15 doi: 10.1001/jamaneurol.2020.0156 – ident: ref29 doi: 10.1016/s0140-6736(21)01341-6 – ident: ref19 doi: 10.1056/nejmoa2206317 – ident: ref27 doi: 10.1161/strokeaha.122.041645
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Snippet	Background and Purpose The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy... The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular...
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SubjectTerms	acute basilar artery occlusion acute stroke meta-analysis posterior circulation Review 신경과학
Title	Endovascular versus Medical Management of Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of the Randomized Controlled Trials
URI	https://www.ncbi.nlm.nih.gov/pubmed/36746382 https://www.proquest.com/docview/2774267574 https://pubmed.ncbi.nlm.nih.gov/PMC9911851 https://doaj.org/article/db008543c6164b7eb6edcea0314f1dec https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002927685
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ispartofPNX	대한뇌졸중영문학회지, 2023, 25(1), 20, pp.81-91
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