• Chun-Hsien Lin, David S Liebeskind, Bruce Ovbiagele, Meng Lee, and Jeffrey L Saver.
• Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi branch, 6 West Section, Chiapu Road, Puzi, Taiwan 613.
• Eur. J. Intern. Med. 2023 Apr 1; 110: 222822-28.

BackgroundThe best management for acute basilar artery occlusion (BAO) has increasingly been clarified by recent randomized controlled trials (RCTs). We conducted a systematic review and meta-analysis of RCTs comparing endovascular therapy (EVT) vs best medical management (BMM).MethodsWe searched PubMed, Embase, the CENTRAL, and ClinicalTrials.gov from January 1, 2000, to November 20, 2022. We included RCTs comparing EVT vs BMM in BAO or bilateral vertebral artery occlusion (VAO). Primary outcome was ambulation (modified Rankin Scale score [mRS] 0-3) at 90 days. Secondary outcomes were independence (mRS 0-2) at 90 days, death by 90 days, and symptomatic intracranial hemorrhage (sICH). Risk ratio (RR) with 95% CI was used as a measure of the association of EVT vs BMM with outcomes.ResultsFinal analyses included 4 RCTs with 988 patients with BAO or VAO. Pooled results showed that EVT vs BMM was associated with an increased rate of 90-day ambulation (RR 1.54, 95% CI 1.16-2.05), independence (RR 1.83, 1.08-3.08) and a reduced risk of mortality (RR 0.76, 0.65-0.89), but an increased risk of sICH (RR 7.48, 2.27-24.62) and the benefits might be confined to patients with BAO but not patients with VAO. EVT effect was modified by occlusion location with the basilar artery, with greatest benefit for proximal, intermediate benefit for middle, and least benefit for distal occlusions.ConclusionEVT compared with BMM might be associated with an increased rate of ambulation, independence and survival but with an increased risk of sICH in patients with acute BAO.Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

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