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

IF 6 1区 医学 Q1 CLINICAL NEUROLOGY
Mohamad Abdalkader, Stephanos Finitsis, Chuanhui Li, Wei Hu, Xinfeng Liu, Xunming Ji, Xiaochuan Huo, Fana Alemseged, Zhongming Qiu, Daniel Strbian, Volker Puetz, James E Siegler, Shadi Yaghi, Kaiz Asif, Piers Klein, Yuyou Zhu, Bruce C V Campbell, Hui-Sheng Chen, Simon Nagel, Georgios Tsivgoulis, Zhongrong Miao, Raul G Nogueira, Tudor G Jovin, Wouter J Schonewille, Thanh N Nguyen
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引用次数: 21

Abstract

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.

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急性基底动脉闭塞的血管内治疗与药物治疗:随机对照试验的系统回顾和荟萃分析
背景与目的:急性基底动脉闭塞(BAO)患者的最佳治疗尚不确定。我们旨在通过随机对照试验(RCTs)的荟萃分析,评估血管内取栓(EVT)与药物治疗(MM)治疗急性BAO的安全性和有效性。方法:我们对急性BAO患者的随机对照试验进行了系统回顾和荟萃分析。我们分析了EVT与MM相比对主要结局(3个月时修正Rankin量表[mRS] 0-3)、次要结局(3个月时mRS 0-2)、症状性颅内出血(siich)和3个月死亡率的综合影响。对于每项研究,效应大小以随机效应和Mantel-Haenszel加权的优势比(ORs)计算。结果:4项rct符合纳入标准,共纳入988例患者。与MM组相比,EVT组在90天出现0-3 mRS的几率更高(45.1% vs 29.1%, OR 1.99, 95%可信区间[CI] 1.04-3.80;P = 0.04)。与MM相比,接受EVT的患者siich更高(5.4% vs 0.8%, OR 7.89, 95% CI 4.10-15.19;结论:在这项系统回顾和荟萃分析中,与MM相比,EVT与BAO患者在卒中症状后24小时内的良好预后和死亡率降低相关
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来源期刊
Journal of Stroke
Journal of Stroke CLINICAL NEUROLOGYPERIPHERAL VASCULAR DISE-PERIPHERAL VASCULAR DISEASE
CiteScore
11.00
自引率
3.70%
发文量
52
审稿时长
12 weeks
期刊介绍: The Journal of Stroke (JoS) is a peer-reviewed publication that focuses on clinical and basic investigation of cerebral circulation and associated diseases in stroke-related fields. Its aim is to enhance patient management, education, clinical or experimental research, and professionalism. The journal covers various areas of stroke research, including pathophysiology, risk factors, symptomatology, imaging, treatment, and rehabilitation. Basic science research is included when it provides clinically relevant information. The JoS is particularly interested in studies that highlight characteristics of stroke in the Asian population, as they are underrepresented in the literature. The JoS had an impact factor of 8.2 in 2022 and aims to provide high-quality research papers to readers while maintaining a strong reputation. It is published three times a year, on the last day of January, May, and September. The online version of the journal is considered the main version as it includes all available content. Supplementary issues are occasionally published. The journal is indexed in various databases, including SCI(E), Pubmed, PubMed Central, Scopus, KoreaMed, Komci, Synapse, Science Central, Google Scholar, and DOI/Crossref. It is also the official journal of the Korean Stroke Society since 1999, with the abbreviated title J Stroke.
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