Aristeidis H Katsanos1, Apostolos Safouris2,3,4, Stavros Nikolakopoulos5,6, Dimitris Mavridis5,7, Nitin Goyal8,9, Marios N Psychogios10, Georgios Magoufis3, Christos Krogias11, Luciana Catanese1, Brian Van Adel12, Guy Raphaeli4,13, Amrou Sarraj14, Marios Themistocleous15, Evangelia Kararizou16, Guillaume Turc17,18,19,20, Adam Arthur9, Andrei V Alexandrov8, Georgios Tsivgoulis2,8. 1. Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada. 2. Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece. 3. Stroke Unit, Metropolitan Hospital, Piraeus, Greece. 4. Interventional Neuroradiology, Rabin Medical Center, Tel Aviv, Israel. 5. Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece. 6. Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. 7. Faculté de Médecine, Université Paris Descartes, Paris, France. 8. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA. 9. Department of Neurosurgery, University of Tennessee/Semmes-Murphey Clinic, Memphis, TN, USA. 10. Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland. 11. Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany. 12. Division of Neurology, Neurosurgery, and Diagnostic Imaging, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada. 13. Department of Neurology, Rabin Medical Center, Tel Aviv, Israel. 14. Department of Neurology, University of Texas at Houston, Houston, TX, USA. 15. Department of Neurosurgery, Pediatric Hospital of Athens, Athens, Greece. 16. First Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece. 17. Department of Neurology, GHU Paris et Psychiatrie et Neurosciences, Paris, France. 18. Université de Paris, Paris, France. 19. INSERM U1266, Paris, France. 20. FHU Neurovasc, Paris, France.
Abstract
BACKGROUND AND PURPOSE: Independent randomized controlled clinical trials (RCTs) have provided robust evidence for endovascular treatment (EVT) as the standard of care treatment for acute large vessel occlusions in the anterior circulation. We examined available studies specific to posterior cerebral circulation ischemic strokes to see if any conclusions can be drawn regarding EVT options. METHODS: We performed a systematic literature search to identify studies evaluating the safety and efficacy of EVT versus standard medical treatment for patients with acute basilar artery occlusion (BAO). We extracted data for outcomes of interest and presented associations between the two groups with the use of risk ratios (RRs) or odds ratios (ORs), with corresponding 95% confidence intervals (CIs). We used a random-effects model to pool the effect estimates. RESULTS: We identified five studies (two RCTs, three observational cohorts) including a total of 1098 patients. Patients receiving EVT had a higher risk of symptomatic intracranial hemorrhage (sICH) compared to those receiving non-interventional medical management (RR 5.42, 95% CI 2.74-10.71). Nonsignificant trends towards modified Rankin Scale (mRS) scores 0-2 (RR 1.02, 95% CI 0.74-1.41), mRS scores 0-3 (RR = 0.97, 95% CI 0.64-1.47), overall functional improvement (OR 0.93, 95% CI 0.57-1.51), and all-cause mortality (RR 1.03, 95% CI 0.78-1.35) at 3 months were seen. CONCLUSION: Although EVT increases the probability of sICH, the available data do not exclude the possibility of improved functional outcomes over standard therapy. As larger studies are challenged by the perceived lack of equipoise in this vulnerable patient population, results of ongoing RCTs are expected to provide substantial input for future meta-analyses.
BACKGROUND AND PURPOSE: Independent randomized controlled clinical trials (RCTs) have provided robust evidence for endovascular treatment (EVT) as the standard of care treatment for acute large vessel occlusions in the anterior circulation. We examined available studies specific to posterior cerebral circulation ischemic strokes to see if any conclusions can be drawn regarding EVT options. METHODS: We performed a systematic literature search to identify studies evaluating the safety and efficacy of EVT versus standard medical treatment for patients with acute basilar artery occlusion (BAO). We extracted data for outcomes of interest and presented associations between the two groups with the use of risk ratios (RRs) or odds ratios (ORs), with corresponding 95% confidence intervals (CIs). We used a random-effects model to pool the effect estimates. RESULTS: We identified five studies (two RCTs, three observational cohorts) including a total of 1098 patients. Patients receiving EVT had a higher risk of symptomatic intracranial hemorrhage (sICH) compared to those receiving non-interventional medical management (RR 5.42, 95% CI 2.74-10.71). Nonsignificant trends towards modified Rankin Scale (mRS) scores 0-2 (RR 1.02, 95% CI 0.74-1.41), mRS scores 0-3 (RR = 0.97, 95% CI 0.64-1.47), overall functional improvement (OR 0.93, 95% CI 0.57-1.51), and all-cause mortality (RR 1.03, 95% CI 0.78-1.35) at 3 months were seen. CONCLUSION: Although EVT increases the probability of sICH, the available data do not exclude the possibility of improved functional outcomes over standard therapy. As larger studies are challenged by the perceived lack of equipoise in this vulnerable patient population, results of ongoing RCTs are expected to provide substantial input for future meta-analyses.