机构：[1]Departments of Radiology and Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA[2]Department of Radiology, Aristotle University of Thessaloniki, Thessaloniki, Greece[3]Stroke Center and Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China神经科系统神经内科首都医科大学宣武医院[4]Department of Neurology and Stroke Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Scienceand Technology of China, Hefei, China[5]Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China神经科系统神经外科首都医科大学宣武医院[6]Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China首都医科大学附属天坛医院[7]Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VC, Australia[8]Department of Neurology, The 903rd Hospital of The Chinese People’s Liberation Army, Hangzhou, China[9]Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland[10]Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany[11]Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany[12]Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA[13]Rhode Island Hospital, Brown University, Providence, RI, USA[14]Amita Health and University of Illinois-Chicago, Chicago, IL, USA[15]Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China[16]Neurology, Heidelberg University Hospital, Heidelberg, Germany[17]Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany[18]Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece[19]Department of Neurology, Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA[20]Department of Neurology, St. Antonius Hospital, Nieuwegein, the Netherlands
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).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.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.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.
第一作者机构：[1]Departments of Radiology and Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
通讯作者：
通讯机构：[20]Department of Neurology, St. Antonius Hospital, Nieuwegein, the Netherlands[*1]Department of Neurology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
推荐引用方式(GB/T 7714)：
Abdalkader Mohamad,Finitsis Stephanos,Li Chuanhui,et al.Endovascular versus Medical Management of Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of the Randomized Controlled Trials[J].JOURNAL OF STROKE.2023,25(1):81-91.doi:10.5853/jos.2022.03755.
APA：
Abdalkader Mohamad,Finitsis Stephanos,Li Chuanhui,Hu Wei,Liu Xinfeng...&on behalf of the BasilaR Artery Ischemia Network STudy of Endovascular versus Medical Management.(2023).Endovascular versus Medical Management of Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of the Randomized Controlled Trials.JOURNAL OF STROKE,25,(1)
MLA：
Abdalkader Mohamad,et al."Endovascular versus Medical Management of Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of the Randomized Controlled Trials".JOURNAL OF STROKE 25..1(2023):81-91
