João Victor Sanders, Luma Maria Tavares de Sousa, Ocílio de Deus, Marion Oliver, Raul G Nogueira, Demetrius Lopes, Krishna Joshi
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Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.ResultsFour RCTs, 988 patients (556 EVT, 432 BMM), were included. EVT increased the risk of SAH (RR 5.14; 95% CI [1.35-19.56]; I² = 0.0%) and PH type 2 (RR 5.53; 95% CI [1.47-20.84]; I² = 0.0%) compared to BMM. No significant differences were observed for any PH (RR 1.91; 95% CI [0.92-3.97]; I² = 0.0%), PH type 1 (RR 0.71; 95% CI [0.22-2.29]; I² = 3.4%), systemic/extracranial hemorrhage (RR 1.06; 95% CI [0.71-1.60]; I² = 12.2%), pneumonia (RR 1.00; 95% CI [0.83-1.21]; I² = 0.0%), or heart failure (RR 2.00; 95% CI [0.34-11.92]; I² = 55.4%).ConclusionIn patients with BAO AIS, EVT is associated with an increased risk of SAH and PH type 2 compared with BMM. There was no significant difference in any PH, PH type 1, systemic/extracranial hemorrhage, pneumonia, and heart failure between groups.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251383070"},"PeriodicalIF":2.1000,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484051/pdf/","citationCount":"0","resultStr":"{\"title\":\"Safety outcomes in endovascular treatment versus best medical management for basilar artery occlusion acute ischemic stroke: A systematic review and meta-analysis of randomized trials.\",\"authors\":\"João Victor Sanders, Luma Maria Tavares de Sousa, Ocílio de Deus, Marion Oliver, Raul G Nogueira, Demetrius Lopes, Krishna Joshi\",\"doi\":\"10.1177/15910199251383070\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>BackgroundEndovascular therapy (EVT) improves functional outcomes and reduces mortality in acute ischemic stroke (AIS) due to basilar artery occlusion (BAO). However, data on hemorrhagic complications and nonneurologic adverse events remain limited. We conducted a systematic review and meta-analysis to assess these outcomes in randomized controlled trials (RCTs) comparing EVT versus best medical management (BMM).MethodsWe searched PubMed, Cochrane Library, and Embase in December 2024 for RCTs comparing EVT and BMM (PROSPERO registry CRD42024617681). Outcomes included any parenchymal hematoma (PH), PH type 1 and 2, subarachnoid hemorrhage (SAH), systemic/extracranial hemorrhage, pneumonia, and heart failure. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.ResultsFour RCTs, 988 patients (556 EVT, 432 BMM), were included. EVT increased the risk of SAH (RR 5.14; 95% CI [1.35-19.56]; I² = 0.0%) and PH type 2 (RR 5.53; 95% CI [1.47-20.84]; I² = 0.0%) compared to BMM. No significant differences were observed for any PH (RR 1.91; 95% CI [0.92-3.97]; I² = 0.0%), PH type 1 (RR 0.71; 95% CI [0.22-2.29]; I² = 3.4%), systemic/extracranial hemorrhage (RR 1.06; 95% CI [0.71-1.60]; I² = 12.2%), pneumonia (RR 1.00; 95% CI [0.83-1.21]; I² = 0.0%), or heart failure (RR 2.00; 95% CI [0.34-11.92]; I² = 55.4%).ConclusionIn patients with BAO AIS, EVT is associated with an increased risk of SAH and PH type 2 compared with BMM. 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引用次数: 0
摘要
背景：脑血管治疗（EVT）改善了基底动脉闭塞（BAO）引起的急性缺血性卒中（AIS）的功能结局，降低了死亡率。然而，关于出血性并发症和非神经系统不良事件的数据仍然有限。我们进行了系统回顾和荟萃分析，以比较EVT与最佳医疗管理（BMM）的随机对照试验（rct）的这些结果。方法我们于2024年12月检索PubMed、Cochrane Library和Embase，检索比较EVT和BMM的rct （PROSPERO注册表CRD42024617681）。结果包括任何实质血肿（PH）， PH 1型和2型，蛛网膜下腔出血（SAH），全身/颅外出血，肺炎和心力衰竭。采用随机效应模型计算合并风险比（RR）和95%置信区间（CI）。结果共纳入4项随机对照试验988例（EVT 556例，BMM 432例）。与BMM相比，EVT增加了SAH （RR 5.14; 95% CI [1.35-19.56]; I²= 0.0%）和PH 2型（RR 5.53; 95% CI [1.47-20.84]; I²= 0.0%）的风险。任何PH （RR 1.91; 95% CI [0.92-3.97]; I²= 0.0%）、PH 1型（RR 0.71; 95% CI [0.22-2.29]; I²= 3.4%）、全身/颅外出血（RR 1.06; 95% CI [0.71-1.60]; I²= 12.2%）、肺炎（RR 1.00; 95% CI [0.83-1.21]; I²= 0.0%）或心力衰竭（RR 2.00; 95% CI [0.34-11.92]; I²= 55.4%）均无显著差异。结论与BMM相比，BAO AIS患者EVT与SAH和PH 2型风险增加相关。两组患者在任何PH值、PH 1型、全身/颅外出血、肺炎和心力衰竭方面均无显著差异。
Safety outcomes in endovascular treatment versus best medical management for basilar artery occlusion acute ischemic stroke: A systematic review and meta-analysis of randomized trials.
BackgroundEndovascular therapy (EVT) improves functional outcomes and reduces mortality in acute ischemic stroke (AIS) due to basilar artery occlusion (BAO). However, data on hemorrhagic complications and nonneurologic adverse events remain limited. We conducted a systematic review and meta-analysis to assess these outcomes in randomized controlled trials (RCTs) comparing EVT versus best medical management (BMM).MethodsWe searched PubMed, Cochrane Library, and Embase in December 2024 for RCTs comparing EVT and BMM (PROSPERO registry CRD42024617681). Outcomes included any parenchymal hematoma (PH), PH type 1 and 2, subarachnoid hemorrhage (SAH), systemic/extracranial hemorrhage, pneumonia, and heart failure. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.ResultsFour RCTs, 988 patients (556 EVT, 432 BMM), were included. EVT increased the risk of SAH (RR 5.14; 95% CI [1.35-19.56]; I² = 0.0%) and PH type 2 (RR 5.53; 95% CI [1.47-20.84]; I² = 0.0%) compared to BMM. No significant differences were observed for any PH (RR 1.91; 95% CI [0.92-3.97]; I² = 0.0%), PH type 1 (RR 0.71; 95% CI [0.22-2.29]; I² = 3.4%), systemic/extracranial hemorrhage (RR 1.06; 95% CI [0.71-1.60]; I² = 12.2%), pneumonia (RR 1.00; 95% CI [0.83-1.21]; I² = 0.0%), or heart failure (RR 2.00; 95% CI [0.34-11.92]; I² = 55.4%).ConclusionIn patients with BAO AIS, EVT is associated with an increased risk of SAH and PH type 2 compared with BMM. There was no significant difference in any PH, PH type 1, systemic/extracranial hemorrhage, pneumonia, and heart failure between groups.
期刊介绍：
Interventional Neuroradiology (INR) is a peer-reviewed clinical practice journal documenting the current state of interventional neuroradiology worldwide. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Original research published in INR is related to the practice of interventional neuroradiology...
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