Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials

BMC Neurology

Research

Benjamin Low¹  Marius Venter¹  Abid Malik¹  Dylan Roi¹  Gavin Fatania¹  Khawar Shabbir¹  Abhinav Singh¹  Harri Jenkins¹  Brian Drumm¹  Dheeraj Kalladka¹  Charles Hall¹  Joseph Kwan¹  Lucio D’Anna¹  Neil Rane¹  Maneesh Patel¹  Soma Banerjee¹  Orsolya Vittay¹  Zoe Brown¹  Sohaa Jamil¹  Kyriakos Lobotesis¹  Isabelle Brooks¹  Oishik Raha¹  Omid Halse¹ 

[1] Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, W6 8RF, London, UK;

关键词: Basilar;    Stroke;    Meta-analysis;    Mechanical thrombectomy;    Randomized controlled trials;   

DOI  :  10.1186/s12883-022-02953-2

 received in 2022-06-14, accepted in 2022-09-13,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe evidence for mechanical thrombectomy in acute basilar artery occlusion has until now remained inconclusive with basilar artery strokes associated with high rates of death and disability. This systematic review and meta-analysis will summarize the available evidence for the effectiveness of mechanical thrombectomy in acute basilar artery occlusion compared to best medical therapy.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials using Embase, Medline and the Cochrane Central Register of Controlled Trials (CENTRAL). We calculated risk ratios (RRs) and 95% confidence intervals (CIs) to summarize the effect estimates for each outcome.ResultsWe performed a random effects (Mantel-Haenszel) meta-analysis of the four included randomized controlled trials comprising a total of 988 participants. We found a statistically significant improvement in the rates of those with a good functional outcome (mRS 0–3, RR 1.54, 1.16–2.06, p = 0.003) and functional independence (mRS 0–2, RR 1.69, 1.05–2.71, p = 0.03) in those who were treated with thrombectomy when compared to best medical therapy alone. Thrombectomy was associated with a higher level of sICH (RR 7.12, 2.16–23.54, p = 0.001) but this was not reflected in a higher mortality rate, conversely the mortality rate was significantly lower in the intervention group (RR 0.76, 0.65–0.89, p = 0.0004).ConclusionsOur meta-analysis of the recently presented randomized controlled studies is the first to confirm the disability and mortality benefit of mechanical thrombectomy in basilar artery stroke.

【 授权许可】

CC BY   
© The Author(s) 2022. corrected publication 2022

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