Kevin Phan1, Steven Phan2, Ya Ruth Huo3, Fangzhi Jia2, Alex Mortimer4. 1. NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia. 2. NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia. 3. Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia. 4. Department of Neuroradiology, North Bristol NHS Trust, Bristol, UK.
Abstract
BACKGROUND: Stent retriever thrombectomy has recently been found to be effective for anterior circulation strokes, but its efficacy for basilar artery occlusion (BAO) is unclear. OBJECTIVE: To carry out a systematic review and meta-analysis to analyze the available evidence for the use of stent retrievers for BAO. METHODS: Two independent reviewers searched six databases for studies reporting outcomes following endovascular treatment for BAO. RESULTS: A total of 17 articles (6 prospective and 11 retrospective) were included. The weighted mean age of patients was 67 years (range 59-82) and 59% were male. Thrombolytic drugs were administered intravenously and intra-arterially in 46% (range 0-88%) and 38% (range 0-90%) of patients, respectively. Weighted pooled estimates of successful recanalization (TICI 2b-3) and good outcome (modified Rankin Scale ≤2) were 80.0% (95% CI 70.7% to 88.0%; I2=80.28%; p<0.001) and 42.8% (95% CI 34.0% to 51.8%; I2=61.83%; p=0.002), respectively. Pooled mortality was 29.4% (95% CI 23.9% to 35.3%; I2=37.01%; p=0.087). Incidence of procedure-related complications and symptomatic hemorrhage was 10.0% (95% CI 3.7% to 18.3%; I2=61.05%; p=0.017) and 6.8% (95% CI 3.5% to 10.8%; I2=37.99%; p=0.08), respectively. CONCLUSIONS: Stent retriever thrombectomy achieves a high rate of recanalization and functional independence while being relatively safe for patients with BAO. Future prospective studies with long-term follow-up are warranted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
BACKGROUND: Stent retriever thrombectomy has recently been found to be effective for anterior circulation strokes, but its efficacy for basilar artery occlusion (BAO) is unclear. OBJECTIVE: To carry out a systematic review and meta-analysis to analyze the available evidence for the use of stent retrievers for BAO. METHODS: Two independent reviewers searched six databases for studies reporting outcomes following endovascular treatment for BAO. RESULTS: A total of 17 articles (6 prospective and 11 retrospective) were included. The weighted mean age of patients was 67 years (range 59-82) and 59% were male. Thrombolytic drugs were administered intravenously and intra-arterially in 46% (range 0-88%) and 38% (range 0-90%) of patients, respectively. Weighted pooled estimates of successful recanalization (TICI 2b-3) and good outcome (modified Rankin Scale ≤2) were 80.0% (95% CI 70.7% to 88.0%; I2=80.28%; p<0.001) and 42.8% (95% CI 34.0% to 51.8%; I2=61.83%; p=0.002), respectively. Pooled mortality was 29.4% (95% CI 23.9% to 35.3%; I2=37.01%; p=0.087). Incidence of procedure-related complications and symptomatic hemorrhage was 10.0% (95% CI 3.7% to 18.3%; I2=61.05%; p=0.017) and 6.8% (95% CI 3.5% to 10.8%; I2=37.99%; p=0.08), respectively. CONCLUSIONS: Stent retriever thrombectomy achieves a high rate of recanalization and functional independence while being relatively safe for patients with BAO. Future prospective studies with long-term follow-up are warranted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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