Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials
Abstract Background The evidence for mechanical thrombectomy in acute basilar artery occlusion has until now remained inconclusive with basilar artery strokes associated with high rates of death and disability. This systematic review and meta-analysis will summarize the available evidence for the ef...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | BMC Neurology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12883-022-02953-2 |
| _version_ | 1811230579329335296 |
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| author | Abid Malik Brian Drumm Lucio D’Anna Isabelle Brooks Benjamin Low Oishik Raha Khawar Shabbir Orsolya Vittay Joseph Kwan Zoe Brown Omid Halse Sohaa Jamil Dheeraj Kalladka Marius Venter Harri Jenkins Neil Rane Abhinav Singh Maneesh Patel Charles Hall Gavin Fatania Dylan Roi Kyriakos Lobotesis Soma Banerjee |
| author_facet | Abid Malik Brian Drumm Lucio D’Anna Isabelle Brooks Benjamin Low Oishik Raha Khawar Shabbir Orsolya Vittay Joseph Kwan Zoe Brown Omid Halse Sohaa Jamil Dheeraj Kalladka Marius Venter Harri Jenkins Neil Rane Abhinav Singh Maneesh Patel Charles Hall Gavin Fatania Dylan Roi Kyriakos Lobotesis Soma Banerjee |
| author_sort | Abid Malik |
| collection | DOAJ |
| description | Abstract Background The evidence for mechanical thrombectomy in acute basilar artery occlusion has until now remained inconclusive with basilar artery strokes associated with high rates of death and disability. This systematic review and meta-analysis will summarize the available evidence for the effectiveness of mechanical thrombectomy in acute basilar artery occlusion compared to best medical therapy. Methods We conducted a systematic review and meta-analysis of randomized controlled trials using Embase, Medline and the Cochrane Central Register of Controlled Trials (CENTRAL). We calculated risk ratios (RRs) and 95% confidence intervals (CIs) to summarize the effect estimates for each outcome. Results We performed a random effects (Mantel-Haenszel) meta-analysis of the four included randomized controlled trials comprising a total of 988 participants. We found a statistically significant improvement in the rates of those with a good functional outcome (mRS 0–3, RR 1.54, 1.16–2.06, p = 0.003) and functional independence (mRS 0–2, RR 1.69, 1.05–2.71, p = 0.03) in those who were treated with thrombectomy when compared to best medical therapy alone. Thrombectomy was associated with a higher level of sICH (RR 7.12, 2.16–23.54, p = 0.001) but this was not reflected in a higher mortality rate, conversely the mortality rate was significantly lower in the intervention group (RR 0.76, 0.65–0.89, p = 0.0004). Conclusions Our meta-analysis of the recently presented randomized controlled studies is the first to confirm the disability and mortality benefit of mechanical thrombectomy in basilar artery stroke. |
| first_indexed | 2024-04-12T10:31:03Z |
| format | Article |
| id | doaj.art-ddb8b606c6924a6090d541f474d6d172 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-04-12T10:31:03Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-ddb8b606c6924a6090d541f474d6d1722022-12-22T03:36:51ZengBMCBMC Neurology1471-23772022-11-012211810.1186/s12883-022-02953-2Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trialsAbid Malik0Brian Drumm1Lucio D’Anna2Isabelle Brooks3Benjamin Low4Oishik Raha5Khawar Shabbir6Orsolya Vittay7Joseph Kwan8Zoe Brown9Omid Halse10Sohaa Jamil11Dheeraj Kalladka12Marius Venter13Harri Jenkins14Neil Rane15Abhinav Singh16Maneesh Patel17Charles Hall18Gavin Fatania19Dylan Roi20Kyriakos Lobotesis21Soma Banerjee22Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustStroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare TrustAbstract Background The evidence for mechanical thrombectomy in acute basilar artery occlusion has until now remained inconclusive with basilar artery strokes associated with high rates of death and disability. This systematic review and meta-analysis will summarize the available evidence for the effectiveness of mechanical thrombectomy in acute basilar artery occlusion compared to best medical therapy. Methods We conducted a systematic review and meta-analysis of randomized controlled trials using Embase, Medline and the Cochrane Central Register of Controlled Trials (CENTRAL). We calculated risk ratios (RRs) and 95% confidence intervals (CIs) to summarize the effect estimates for each outcome. Results We performed a random effects (Mantel-Haenszel) meta-analysis of the four included randomized controlled trials comprising a total of 988 participants. We found a statistically significant improvement in the rates of those with a good functional outcome (mRS 0–3, RR 1.54, 1.16–2.06, p = 0.003) and functional independence (mRS 0–2, RR 1.69, 1.05–2.71, p = 0.03) in those who were treated with thrombectomy when compared to best medical therapy alone. Thrombectomy was associated with a higher level of sICH (RR 7.12, 2.16–23.54, p = 0.001) but this was not reflected in a higher mortality rate, conversely the mortality rate was significantly lower in the intervention group (RR 0.76, 0.65–0.89, p = 0.0004). Conclusions Our meta-analysis of the recently presented randomized controlled studies is the first to confirm the disability and mortality benefit of mechanical thrombectomy in basilar artery stroke.https://doi.org/10.1186/s12883-022-02953-2BasilarStrokeMeta-analysisMechanical thrombectomyRandomized controlled trials |
| spellingShingle | Abid Malik Brian Drumm Lucio D’Anna Isabelle Brooks Benjamin Low Oishik Raha Khawar Shabbir Orsolya Vittay Joseph Kwan Zoe Brown Omid Halse Sohaa Jamil Dheeraj Kalladka Marius Venter Harri Jenkins Neil Rane Abhinav Singh Maneesh Patel Charles Hall Gavin Fatania Dylan Roi Kyriakos Lobotesis Soma Banerjee Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials BMC Neurology Basilar Stroke Meta-analysis Mechanical thrombectomy Randomized controlled trials |
| title | Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials |
| title_full | Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials |
| title_fullStr | Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials |
| title_full_unstemmed | Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials |
| title_short | Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials |
| title_sort | mechanical thrombectomy in acute basilar artery stroke a systematic review and meta analysis of randomized controlled trials |
| topic | Basilar Stroke Meta-analysis Mechanical thrombectomy Randomized controlled trials |
| url | https://doi.org/10.1186/s12883-022-02953-2 |
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