A meta-analysis of thrombectomy trials for basilar artery occlusion stroke

The use of endovascular thrombectomy (EVT) in acute ischemic stroke due to basilar artery occlusion (BAO) has been investigated in several randomized, controlled trials in recent years, obtaining mixed results. While early studies were hampered by sample size and study design limitations, two large-scale trials published in 2022 demonstrated improved outcomes in carefully selected patients with BAO undergoing thrombectomy, compared to best medical management. Adnan Qureshi, MD, University of Missouri-Columbia, Columbia, MO, presents a meta-analysis of all four randomized controlled trials assessing EVT in BAO, aiming to provide conclusive evidence on its use. Primary endpoint analysis of close to 1000 patients found significantly greater rates of favorable outcome (mRS 0-3) at 90 days in the EVT group compared with the best medical management group (OR 1.99). Endovascular intervention also significantly reduced mortality at 90 days. As expected, there was a higher risk of intracranial hemorrhage (ICH) in the EVT arm, compared to best medical management (OR 8.19). Dr Qureshi comments on how these data may be incorporated into future guidelines on BAO management. This interview took place during the International Stroke Conference (ISC) 2023 in Dallas, TX.

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