Outcomes of endovascular treatment of basilar artery occlusion in the stent retriever era: a systematic review and meta-analysis

Background: Stent retriever thrombectomy has recently been found to be effective for anterior circulation strokes, but its efficacy for basilar artery occlusion (BAO) is unclear. Objective: To carry out a systematic review and meta-analysis to analyze the available evidence for the use of stent retrievers for BAO. Methods: Two independent reviewers searched six databases for studies reporting outcomes following endovascular treatment for BAO. Results: A total of 17 articles (6 prospective and 11 retrospective) were included. The weighted mean age of patients was 67years (range 59-82) and 59% were male. Thrombolytic drugs were administered intravenously and intra-arterially in 46% (range 0-88%) and 38% (range 0-90%) of patients, respectively. Weighted pooled estimates of successful recanalization (TICI 2b-3) and good outcome (modified Rankin Scale ≤2) were 80.0% (95% CI 70.7% to 88.0%; I 2 =80.28%; p<0.001) and 42.8% (95% CI 34.0% to 51.8%; I 2 =61.83%; p=0.002), respectively. Pooled mortality was 29.4% (95% CI 23.9% to 35.3%; I 2 =37.01%; p=0.087). Incidence of procedure-related complications and symptomatic hemorrhage was 10.0% (95% CI 3.7% to 18.3%; I 2 =61.05%; p=0.017) and 6.8% (95% CI 3.5% to 10.8%; I 2 =37.99%; p=0.08), respectively. Conclusions Stent retriever thrombectomy achieves a high rate of recanalization and functional independence while being relatively safe for patients with BAO. Future prospective studies with long-term follow-up are warranted.