Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion

Abstract

Background and purposeIt remains controversial if endovascular treatment (EVT) can improve the outcome of patients with acute basilar artery occlusion (BAO). This study aims to compare the functional outcomes between EVT with and without intravenous thrombolysis (IVT) first in patients who had acute ischaemic stroke (AIS) due to BAO.MethodsPatients who had AIS with BAO who underwent EVT within 24 hours of onset were enrolled in this multicentre cohort study, and the efficacy and safety were compared between IVT+EVT and direct EVT. The primary outcome was 90-day functional independence. All outcomes were assessed with adjusted OR (aOR) from the multivariable logistic regression. In addition, a meta-analysis was performed on all recently published pivotal studies on functional independence after EVT in patients with BAO.ResultsOf 310 enrolled patients with BAO, 241 (78%) were treated with direct EVT and 69 (22%) with IVT+EVT. Direct EVT was associated with a worse functional outcome (aOR, 0.46 (95% CI 0.24 to 0.85), p=0.01). IVT+EVT was associated with a lower percentage of patients who needed ≥3 passes of stent retriever (10.14% vs 20.75%). The meta-analysis regression revealed a potential positive correlation between bridging with IVT first and functional independence (r=0.14 (95% CI 0.05 to 0.24), p<0.01).ConclusionsThis study showed that compared with direct EVT, EVT with IVT first was associated with better functional outcomes in patients with BAO treated within 24 hours of onset. The meta-analysis demonstrated similar favourable efficacy of IVT first followed by EVT in patients with BAO.

Bridging thrombolysis improves survival rates at 90 days compared with direct mechanical thrombectomy alone in acute ischemic stroke due to basilar artery occlusion: a systematic review and meta-analysis of 1096 patients

“…After screening of titles and abstracts, 51 publications were reviewed in full text. A total of three studies,20–22 comparing bridging IVT with direct MT in 1096 patients with stroke due to BAO met the eligibility criteria for inclusion in our meta-analysis (figure 1). Reliability of study selection between observers was substantial at both the title and abstract screening stage (Cohen’s κ=0.83) and the full-text review stage (Cohen’s κ=1.00) 23…”

“…All included studies were non-randomized multicenter retrospective cohort studies 20–22. Data were collected across large volume neurointervention centers across eight countries: China, Germany, Greece, Italy, Singapore, Sweden, Taiwan, and the United Kingdom.…”

“…On assessing the risk of bias using the Joanna Briggs Institute checklist, all three studies attained a full score of 11, signifying that all three were good studies (see online supplemental table S4). 20–22 Follow-up duration was 90 days.…”

“…Of the total 1096 patients, 749 were male (68.3%) and 347 were female (31.7%) 20–22. Three hundred and sixty-two patients underwent MT with bridging IVT, while 734 patients underwent direct MT.…”

Endovascular thrombectomy versus standard medical treatment for stroke patients with acute basilar artery occlusion: a systematic review and meta-analysis

“…Interestingly, their subgroup analysis also suggested that BAO patients with large artery atherosclerosis might benefit from bridging therapy compared with EVT alone 29. However, the findings of another study conducted by Nie et al showed that BAO patients treated with bridging therapy had better functional outcomes than those who underwent EVT alone 30…”