Abstract
Introduction
It is poorly understood if endovascular thrombectomy (EVT) with or without intravenous
thrombolysis (IVT) better facilitates clinical outcomes in patients with acute basilar
artery occlusion (BAO) ischemic stroke.
Methods
A systematic literature review and meta-analysis was completed to investigate the
outcomes of EVT with IVT versus direct EVT alone in acute BAO. Data was collected
from the literature and pooled with the authors’ institutional experience. The primary
outcome measure was 90-day modified Rankin sale (mRS) of 0-2. Secondary measures were
successful post-thrombectomy recanalization defined as mTICI ≥2b, 90-day mortality,
and rate of symptomatic ICH.
Results
Our institutional experience combined with three multicenter studies resulted in a
total of 1,127 patients included in the meta-analysis. 756 patients underwent EVT
alone, while 371 were treated with EVT+IVT. Patients receiving EVT+IVT had a higher
odds of achieving a 90-day mRS of ≤ 2 compared to EVT alone (OR: 1.50, 95% CI 1.15
to 1.95, P =0.002, I2 =0%). EVT+IVT also had a lower odds of 90-day mortality (OR: 0.57, 95% CI 0.37 to
0.89, P=0.01, I2=24%). There was no difference in sICH between the two groups (OR: 1.0, 95% CI: 0.56
to 1.79, P=0.99, I2=0%). There was also no difference in post-thrombectomy recanalization rates defined
as mTICI ≥2b (OR: 1.11, 95% CI 0.70 to 1.75, P = 0.65, I2=37%).
Conclusions
On meta-analysis, EVT with bridging IVT results in superior 90-day functional outcomes
and lower 90-day mortality without increase in symptomatic ICH. These findings likely
deserve further validation in a randomized controlled setting.
Keywords
Abbreviations:
AIS (Acute Ischemic Stroke), LVO (Large Vessel Occlusion), TICI (Treatment in Cerebral Ischemia), mRS (Modified Rankin Score)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: October 28, 2022
Accepted:
October 18,
2022
Received in revised form:
October 16,
2022
Received:
June 21,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106847
Copyright
© 2022 Elsevier Inc. All rights reserved.
