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

被引：80

作者：

Abdalkader, Mohamad ^{[1
,2
]}

Finitsis, Stephanos ^{[3
]}

Li, Chuanhui ^{[4
]}

Hu, Wei ^{[5
]}

Liu, Xinfeng ^{[5
]}

Ji, Xunming ^{[6
]}

Huo, Xiaochuan ^{[7
]}

Alemseged, Fana ^{[8
]}

Qiu, Zhongming ^{[9
]}

Strbian, Daniel ^{[10
]}

Puetz, Volker ^{[11
,12
]}

Siegler, James E. ^{[13
]}

Yaghi, Shadi ^{[14
]}

Asif, Kaiz ^{[15
,16
]}

Klein, Piers ^{[1
,2
]}

Zhu, Yuyou ^{[5
]}

Campbell, Bruce C. V. ^{[9
]}

Chen, Hui-Sheng ^{[17
]}

Nagel, Simon ^{[18
,19
]}

Tsivgoulis, Georgios ^{[20
]}

Miao, Zhongrong ^{[7
]}

Nogueira, Raul G. ^{[21
]}

Jovin, Tudor G.

Schonewille, Wouter J. ^{[22
]}

Nguyen, Thanh N. ^{[1
,2
]}

机构：

[1] Boston Univ Chobanian, Boston Med Ctr, Dept Radiol & Neurol, Boston, MA USA

[2] Avedisian Sch Med, Boston, MA USA

[3] Aristotle Univ Thessaloniki, Dept Radiol, Thessaloniki, Greece

[4] Capital Med Univ, Xuanwu Hosp, Dept Neurol, Beijing, Peoples R China

[5] Univ Sci & Technol China, Affiliated Hosp 1, Stroke Ctr, Dept Neurol,USTC, Hefei, Peoples R China

[6] Capital Med Univ, Xuanwu Hosp, Dept Neurosurg, Beijing, Peoples R China

[7] Beijing Tiantan Hosp, Intervent Neuroradiol, Beijing, Peoples R China

[8] Univ Melbourne, Royal Melbourne Hosp, Melbourne Brain Ctr, Med & Neurol, Parkville, Vic, Australia

[9] Chinese Peoples Liberat Army, Dept Neurol, 903 Hosp, Hangzhou, Peoples R China

[10] Univ Helsinki, Helsinki Univ Hosp, Neurol, Koekoekslaan 1, NL-3435 CM Helsinki, Finland

[11] Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Neurol, Dresden, Germany

[12] Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Dresden Neurovasc Ctr, Dresden, Germany

[13] Cooper Univ Hosp, Cooper Neurol Inst, Camden, NJ USA

[14] Brown Univ, Rhode Isl Hosp, Providence, RI USA

[15] Univ Illinois, Chicago, IL USA

[16] Amita Hlth, Chicago, IL USA

[17] Gen Hosp Northern Theatre Command, Dept Neurol, Shenyang, Peoples R China

[18] Heidelberg Univ Hosp, Neurol, Heidelberg, Germany

[19] Klinikum Ludwigshafen, Neurol, Ludwigshafen, Germany

[20] Natl & Kapodistrian Univ Athens, Attikon Univ Hosp, Dept Neurol, Athens, Greece

[21] Univ Pittsburgh, Med Ctr, Dept Neurol, Neurosurg, Pittsburgh, PA USA

[22] St Antonius Hosp, Dept Neurol, Nieuwegein, Netherlands

来源：

JOURNAL OF STROKE | 2023年 / 25卷 / 01期

关键词：

Acute stroke; Acute basilar artery occlusion; Posterior circulation; Meta-analysis; INTRAVENOUS T-PA; MECHANICAL THROMBECTOMY; ISCHEMIC-STROKE; THERAPY; THROMBOLYSIS; CIRCULATION; MULTICENTER; UROKINASE; OUTCOMES;

D O I：

10.5853/jos.2022.03755

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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.

引用

页码：81 / 91

页数：11

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