BACKGROUND Acute basilar artery occlusion (BAO) is a devastating condition if untreated. The optimal treatment strategy, however, is unknown. Historically, interventional approaches have been favored over intravenous thrombolysis (IVT), although this is not supported by good evidence. The aim of this systematic review and meta-analysis was to summarize and compare the results for treatment modalities of BAO, namely, IVT and interventional stent retriever thrombectomy (SRT). METHODS Studies on IVT and SRT in BAO were systematically searched. Successful recanalization (TICI ≥2b), favorable clinical outcome (modified Rankin Scale score ≤2), mortality, and the rate of symptomatic intracranial hemorrhage (SICH) were the target parameters. Only studies with ≥15 patients were included. IVT prior to SRT was allowed. Studies were excluded (1) if >1 thrombectomy device was used in >50% of the patients and (2) when data on outcome or treatment could not be parsed (e.g. registries). Odds ratios (ORs) were calculated using Mantel-Haenszel risk ratio estimation. Results are given as OR and the 95% confidence interval (95% CI). The χ2 test was used to compare the outcome parameters clinical outcome, recanalization, mortality, and SICH. RESULTS A total of 17 studies (4 on IVT and 13 on SRT) with a total of 672 patients (IVT, n = 314; SRT, n = 358) were identified. Cumulatively, we found a highly significantly improved clinical outcome (43 vs. 31%, p = 0.004, OR [95% CI] = 1.66 [1.21, 2.76]), increased recanalization rate (88 vs. 60%, p < 0.00001, OR [95% CI] = 3.99 [2.73, 5.84]), and decreased mortality (26 vs. 41%, p = 0.0004, OR [95% CI] = 1.86 [1.33, 2.61]), as well as an equal rate of SICH (5 vs. 7%, p = 0.15, OR [95% CI] = 1.68 [0.82, 3.43]), in patients treated with SRT compared to those treated with IVT alone. CONCLUSIONS The data from this meta-analysis suggest a possible superiority of SRT over IVT, pending positive results of randomized controlled trials. According to international recommendations, patients with BAO should preferentially be treated with SRT; if no contraindications exist, IVT should not be withheld.

中文翻译：

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支架回收器血栓切除术可能提高急性基底动脉闭塞的再通率、改善临床结果并降低死亡率：系统评价和荟萃分析。


背景技术如果不及时治疗，急性基底动脉闭塞（BAO）是一种毁灭性的疾病。然而，最佳治疗策略尚不清楚。从历史上看，介入方法比静脉溶栓（IVT）更受青睐，尽管这没有得到充分证据的支持。本系统评价和荟萃分析的目的是总结和比较 BAO 治疗方式的结果，即 IVT 和介入支架取栓术 (SRT)。方法系统检索BAO中IVT和SRT的研究。成功的再通（TICI ≥2b）、良好的临床结果（改良Rankin量表评分≤2）、死亡率和症状性颅内出血（SICH）发生率是目标参数。仅纳入≥15 名患者的研究。允许在 SRT 之前进行 IVT。 (1) 如果 >50% 的患者使用了 >1 血栓切除装置，以及 (2) 当无法解析结果或治疗数据（例如登记）时，研究被排除。使用 Mantel-Haenszel 风险比估计计算优势比 (OR)。结果以 OR 和 95% 置信区间 (95% CI) 形式给出。 χ2 检验用于比较结果参数临床结果、再通、死亡率和 SICH。结果 共有 17 项研究（4 项关于 IVT，13 项关于 SRT），共有 672 名患者（IVT，n = 314；SRT，n = 358）。总的来说，我们发现临床结果显着改善（43% vs. 31%，p = 0.004，OR [95% CI] = 1.66 [1.21, 2.76]），再通率增加（88% vs. 60%，p < 0.00001） ，OR [95% CI] = 3.99 [2.73, 5.84]），死亡率降低（26 vs. 41%，p = 0.0004，OR [95% CI] = 1.86 [1.33, 2.61]），以及同等水平SICH 发生率（5% vs. 7%，p = 0.15，OR [95% CI] = 1.68 [0.82, 3.43]），与仅接受 IVT 治疗的患者相比，接受 SRT 治疗的患者。结论 这项荟萃分析的数据表明，SRT 可能优于 IVT，尚待随机对照试验的积极结果。根据国际建议，BAO患者应优先接受SRT治疗；如果不存在禁忌症，则不应停止 IVT。