Gandhi, Chirag D.

Background Acute ischemic stroke attributed to basilar artery occlusion is known to be associated with high rates of mortality and disability. However, the previous clinical trials did not provide evidence to support the efficacy of endovascular treatment (EVT) in patients with basilar artery occlusion. The purpose of this study was to provide updated evidence about EVT's benefits and safety profile with the recent update from both the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) and the Basilar Artery Occlusion Chinese Endovascular Trial (BAOCHE) trials. Methods We searched for eligible articles from inception to November 1, 2022, in 5 databases and included all randomized controlled trials with no restrictions on the publication date or language. Meta‐analysis statistics were performed using R software version 4.2.1. Results The rate of modified Rankin scale score of 0 to 3 was significantly higher in the EVT group compared with best medical treatment (risk ratio [RR], 1.54 [95% CI, 1.16–2.04]; P value = 0.002), and the same was observed for the rate of modified Rankin scale score 0 to 2 (RR, 1.83 [95% CI, 1.08–3.08]; P value = 0.024). Moreover, there was a significant reduction in the 90‐day mortality in the EVT group (RR, 0.76 [95% CI, 0.65–0.89]; P value = 0.002). However, there was a significantly higher rate of symptomatic intracerebral hemorrhage in the EVT group compared with best medical treatment (RR, 7.48 [95% CI, 2.27–24.61]; P value <0.001). Conclusions EVT may confer a clinical benefit to patients with acute ischemic stroke caused by basilar artery occlusion. Because of the small number of included studies and because all of them were conducted in the Chinese population, further trials might be needed to confirm and further investigate the generalizability of these results.

ObjectiveTo evaluate clinical outcomes of endovascular thrombectomy (EVT) for acute basilar artery occlusion (BAO) using population‐level data from the United States.MethodsWeighted discharge data from the National Inpatient Sample were queried to identify adult patients with acute BAO during the period of 2015 to 2019 treated with EVT or medical management only. Complex samples statistical methods and propensity‐score adjustment using inverse probability of treatment weighting (IPTW) were performed to assess clinical endpoints.ResultsAmong 3,950 BAO patients identified, 1,425 (36.1%) were treated with EVT [mean age 66.7 years, median National Institute of Health Stroke Scale (NIHSS) score 22]. On unadjusted analysis, 155 (10.9%) EVT patients achieved favorable functional outcomes (discharge disposition to home without services), while 515 (36.1%) experienced in‐hospital mortality, and 20 (1.4%) developed symptomatic intracranial hemorrhage (sICH). Following propensity‐score adjustment by IPTW accounting for age, stroke severity, and comorbidity burden, EVT was independently associated with favorable functional outcome [adjusted odds ratio (aOR) 1.25, 95% confidence interval (CI) 1.07, 1.46; p = 0.004], but not with in‐hospital mortality or sICH. In an IPTW‐adjusted sub‐group analysis of patients with NIHSS scores >20, EVT was associated with both favorable functional outcome (discharge disposition to home or to acute rehabilitation) (aOR 1.55, 95% CI 1.24, 1.94; p < 0.001) and decreased mortality (aOR 0.78, 95% CI 0.69, 0.89; p < 0.001), but not with sICH.InterpretationThis retrospective population‐based analysis using a large national registry provides real‐world evidence of a potential benefit of EVT in acute BAO patients. ANN NEUROL 2023;94:55–60