Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysis

Abstract

Recanalization of acute BAO leads to reduction in mortality by two-fold and reduction in the risk of DoD by 1.5-fold. This study underscores the equipoise in acute BAO for comparing systemic and endovascular therapies, and testing different time windows through RCTs.

Combined Use of Mechanical Thrombectomy with Angioplasty and Stenting for Acute Basilar Occlusions with Underlying Severe Intracranial Vertebrobasilar Stenosis: Preliminary Experience from a Single Chinese Center

“…11,12,14,18 No patients had procedure-related intracerebral hemorrhage on postoperative imaging; these results compared favorably with the 14% intracerebral hemorrhage rate in the endovascular treatment group from a recent meta-analysis. 19 There were 2 mortalities, neither of which were procedure-related. On discharge, an improvement of NIHSS score of Ն10 points was noted for 10 patients (76.9%).…”

Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN

“…12 The SWIFT PRIME trial (Solitaire TM With the Intention For Thrombectomy as PRIMary treatment for acute ischemic strokE) was prematurely stopped after a positive interim analysis of the first 196 patients. To be randomized, all patients needed to have received IVT < 4.5 h, an NIHSS score between 8 and 29, a CTA or magnetic resonance angiography (MRA) showing an occlusion of the intracranial carotid or M1 segment of the MCA without extracranial carotid occlusion, an ASPECTS > 6 and CT hypodensity (or magnetic resonance imaging (MRI) hyperintensity) <1/3 of the MCA territory, and treatable <6 h. Results (two co-primary endpoints): The OR for an mRS shift at 90 days with thrombectomy using the Solitaire TM FR stent retriever was highly significant (p < 0.001), and mRS 0-2 at 90 days was 60.2% in thrombectomy patients vs. 35.5% in controls (p < 0.001, NNT ¼ 4). There was a trend for reduced mortality.…”

“…A recent meta-analysis of 45 observational studies (n ¼ 2056) of reperfusion vs. no reperfusion of acute basilar occlusion showed NNT of 3 and 2.5 to decrease death or dependency and death alone, respectively. 35 Single-centre studies with samples less than 100 patients have shown good functional outcomes following thrombectomy of the basilar artery, ranging from 30% 36,37 to 48%. [38][39][40] Experience at the Karolinska Hospital showed a 57% rate of good functional outcome (95% CI 37% to 75%), and of 73% (95% CI 50% to 89%) when there were no signs of acute infarction prior to treatment, with about 21% mortality.…”

Basilar Occlusion Syndromes

“…48 In lieu of randomized controlled trials, a recent meta-analysis by Kumar et al showed that recanalization was associated with a 1.5-fold reduction in dependency and 2.0-fold reduction in mortality. 10 Despite apparent improvements in outcomes over time, the best therapy to achieve recanalization is unknown.…”

“…8,9 Successful recanalization appears to be the single most important predictor of a good outcome. 10 The thrombolysis in cerebral infarction (TICI) score is a widely used method to describe angiographic findings after endovascular treatment of acute ischemic stroke. Although definitions vary within the literature, TICI 2b (>50% reperfusion of vascular territory according to the original TICI 45 and >67% of the vascular territory in the modified TICI 46 ) and TICI 3 (100% reperfusion) are generally regarded to represent a successful angiographic outcome.…”