Clinical Outcomes Of Recanalization Therapy In Acute Basilar Artery Occlusion:a Meta-analysis

ObjectiveAcute basilar artery occlusion(BAO)is a rare form of ischemic stroke with a feature of high mortality and disability.Intravenous thrombolysis(IVT)and stent retriever thrombectomy(SRT)are most common and recommended treatments for acute BAO.Worldwide,there is no consensus regarding choice of the two treatment strategies.Due to the low incidence,currently there is no clinical randomized controlled trial yet to find the optimal treatment plan for acute BAO.To identify the respective relationship between recanalization and clinical outcomes of IVT and SRT in the treatment of acute BAO,relevant international literature was reviewed and meta-analysis was carried out to obtain more systematic and quantitative conclusions.The above work also analyzes the overall prognosis and safety of IVT and SRT treatments and,therefore,provides effective reference for the treatment selection of acute BAO.MethodsPubMed and Cochrane Library were systematically searched to identify relevant literature on IVT and SRT for acute BAO from inception to October 2017.According to the inclusion and exclusion criteria,two reviewers independently completed the selection of studies,data extraction and quality evaluation.All analyses were performed using Revman 5.3 and R 3.4.2.Finally,sensitivity analyses were performed and publication bias was evaluated.ResultsThe study summarizes 21 relevant articles and 627 patients suffering from acute BAO.The poor outcome of the vascular recanalization group was significantly lower than that of the un-recanalization group(RR=0.63,95%CI:0.55-0.72,P<0.0001),and the correspond ing mortality rate was also significantly reduced(RR=0.37,95%CI:0.27-0.52,P<0.0001).The rates of vascular recanalization,poor outcome,mortality,and symptomatic intracranial hemorrhage(SICH)in the IVT group for acute BAO were 60%(95% CI: 53%-66%),67%(95%CI: 61%-73%),35%(95% CI: 20%-51%),and 8%(95% CI: 5%-13%),respectively.In the SRT group,the rates were 86%(95%CI: 80%-92%),61%(95%CI: 56%-66%),26%(95%CI:19%-33%),and 5%(95%CI: 2%-10%),respectively.ConclusionsRecanalization can effectively reduce the poor outcome and mortality in patients with acute BAO.Recanalization therapy must be implemented for these patients.Compared with intravenous thrombolysis,stent retriever thrombectomy can significantly increase the rate of vascular recanalization in acute BAO and reduce the rate of poor outcome,mortality and SICH.This study has demonstrated the effectiveness and safety of stent retriever thrombectomy.For eligible patients with acute BAO,stent retriever thrombectomy is recommended.However,due to the limitations of this study,large clinical randomized controlled trials are still needed to further verify this study in the future.