open access

Vol 51, No 6 (2017)
Review article
Submitted: 2017-03-24
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Treatment of acute basilar artery occlusion: Systematic review and meta-analysis

Adam Wyszomirski, Sebastian Szczyrba, Dominika Tomaka, Bartosz Karaszewski
DOI: 10.1016/j.pjnns.2017.07.012
·
Neurol Neurochir Pol 2017;51(6):486-496.

open access

Vol 51, No 6 (2017)
Review article
Submitted: 2017-03-24

Abstract

Introduction

Acute basilar artery occlusion (BAO) results in strokes characterized by poor outcome. Intravenous and intraarterial thrombolysis with rt-PA (IV rt-PA and IA rt-PA, respectively) and mechanical thrombectomy (MT) are the most commonly used techniques to treat BAO, but their efficacy remains unclear. Unlike in previous papers, we compared all three methods of the treatment in a single work, including an update of meta-analysis regarding each of the three therapeutic approaches with recent trials.

Methods

We systematically reviewed all original studies testing the efficacy of any of the three basic methods of BAO treatment dated up to the end of Jan 2017.

Results

The final analysis included 31 studies that summarized 1358 patients. These subjects were organized into three therapeutic groups: IV rt-PA, IA rt-PA±IV rt-PA, MT±IV rt-PA±IA rt-PA. The weighted pooled estimates of a favorable outcome (mRS 0–2) were 32.57% (95% CI 16.44–51.03%/I2=67.5%, p=0.0795) in the first group, 22.56% (95% CI 16.85–28.79%/I2=52.1%, p=0.027) in the second group, and 37.04% (95% CI 32.27–41.92%/I2=32%, p=0.0895) in the third group. The Q-test subgroup analysis revealed the statistical superiority of MT±IV rt-PA±IA rt-PA over IA rt-PA±IV rt-PA (mRS 0–2: p=0.0003, mRS 6: p=0.0010) and over any rt-PA administration (either IV rt-PA or IA rt-PA±IV rt-PA) (mRS 0–2: p=0.0006, mRS 6: p=0.0056).

Conclusions

Current data on the effects of the three basic approaches of the treatment of BAO are insufficient to generate high-class EBM guidelines. MT seems to be the most effective method of the treatment of acute BAO. The efficacy of IV or IA thrombolytic therapy in this indication remains unclear.

Abstract

Introduction

Acute basilar artery occlusion (BAO) results in strokes characterized by poor outcome. Intravenous and intraarterial thrombolysis with rt-PA (IV rt-PA and IA rt-PA, respectively) and mechanical thrombectomy (MT) are the most commonly used techniques to treat BAO, but their efficacy remains unclear. Unlike in previous papers, we compared all three methods of the treatment in a single work, including an update of meta-analysis regarding each of the three therapeutic approaches with recent trials.

Methods

We systematically reviewed all original studies testing the efficacy of any of the three basic methods of BAO treatment dated up to the end of Jan 2017.

Results

The final analysis included 31 studies that summarized 1358 patients. These subjects were organized into three therapeutic groups: IV rt-PA, IA rt-PA±IV rt-PA, MT±IV rt-PA±IA rt-PA. The weighted pooled estimates of a favorable outcome (mRS 0–2) were 32.57% (95% CI 16.44–51.03%/I2=67.5%, p=0.0795) in the first group, 22.56% (95% CI 16.85–28.79%/I2=52.1%, p=0.027) in the second group, and 37.04% (95% CI 32.27–41.92%/I2=32%, p=0.0895) in the third group. The Q-test subgroup analysis revealed the statistical superiority of MT±IV rt-PA±IA rt-PA over IA rt-PA±IV rt-PA (mRS 0–2: p=0.0003, mRS 6: p=0.0010) and over any rt-PA administration (either IV rt-PA or IA rt-PA±IV rt-PA) (mRS 0–2: p=0.0006, mRS 6: p=0.0056).

Conclusions

Current data on the effects of the three basic approaches of the treatment of BAO are insufficient to generate high-class EBM guidelines. MT seems to be the most effective method of the treatment of acute BAO. The efficacy of IV or IA thrombolytic therapy in this indication remains unclear.

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Keywords

Ischemic stroke, Basilar artery occlusion, Thrombolysis, Thrombectomy, Embolectomy

About this article
Title

Treatment of acute basilar artery occlusion: Systematic review and meta-analysis

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 51, No 6 (2017)

Pages

486-496

DOI

10.1016/j.pjnns.2017.07.012

Bibliographic record

Neurol Neurochir Pol 2017;51(6):486-496.

Keywords

Ischemic stroke
Basilar artery occlusion
Thrombolysis
Thrombectomy
Embolectomy

Authors

Adam Wyszomirski
Sebastian Szczyrba
Dominika Tomaka
Bartosz Karaszewski

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