BACKGROUND AND PURPOSE The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared to medical management (MM) for acute BAO through a meta-analysis of randomized controlled trials (RCTs). METHODS We performed a systematic review and meta-analysis of RCTs of patients with acute BAO. We analyzed the pooled effect of EVT compared to MM on the primary outcome (modified Rankin Scale [mRS] of 0-3 at 3 months), secondary outcome (mRS 0-2 at 3 months), symptomatic intracranial hemorrhage (sICH), and 3-month mortality rates. For each study, effect sizes were computed as odds ratios (ORs) with random effects and Mantel-Haenszel weighting. RESULTS Four RCTs met inclusion criteria including 988 patients. There were higher odds of mRS of 0-3 at 90 days in the EVT versus MM group (45.1% vs. 29.1%, OR 1.99, 95% confidence interval [CI] 1.04-3.80; P=0.04). Patients receiving EVT had a higher sICH compared to MM (5.4% vs. 0.8%, OR 7.89, 95% CI 4.10-15.19; P<0.01). Mortality was lower in the EVT group (35.5% vs. 45.1%, OR 0.64, 95% CI 0.42-0.99; P=0.05). In an analysis of two trials with BAO patients and National Institutes of Health Stroke Scale (NIHSS) <10, there was no difference in 90-day outcomes between EVT versus MM. CONCLUSION In this systematic review and meta-analysis, EVT was associated with favorable outcome and decreased mortality in patients with BAO up to 24 hours from stroke symptoms compared to MM. The treatment effect in BAO patients with NIHSS <10 was less certain. Further studies are of interest to evaluate the efficacy of EVT in basilar occlusion patients with milder symptoms.

中文翻译：

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急性基底动脉闭塞的血管内治疗与药物治疗：随机对照试验的系统评价和荟萃分析。

背景和目的急性基底动脉闭塞 (BAO) 患者的最佳治疗尚不确定。我们旨在通过随机对照试验 (RCT) 的荟萃分析，评估血管内血栓切除术 (EVT) 与药物治疗 (MM) 相比治疗急性 BAO 的安全性和有效性。方法 我们对急性 BAO 患者的随机对照试验进行了系统回顾和荟萃分析。我们分析了 EVT 与 MM 相比对主要结局（3 个月时改良 Rankin 量表 [mRS] 为 0-3）、次要结局（3 个月时 mRS 0-2）、症状性颅内出血 (sICH) 和3 个月死亡率。对于每项研究，效应大小被计算为具有随机效应和 Mantel-Haenszel 权重的比值比 (OR)。结果 4 个随机对照试验符合纳入标准，包括 988 名患者。与 MM 组相比，EVT 组在 90 天时 mRS 为 0-3 的几率更高（45.1% 对 29.1%，OR 1.99，95% 置信区间 [CI] 1.04-3.80；P=0.04）。与 MM 相比，接受 EVT 的患者有更高的 sICH（5.4% 对 0.8%，OR 7.89，95% CI 4.10-15.19；P<0.01）。EVT 组的死亡率较低（35.5% 对 45.1%，OR 0.64，95% CI 0.42-0.99；P=0.05）。在对 BAO 患者和美国国立卫生研究院卒中量表 (NIHSS) <10 的两项试验的分析中，EVT 与 MM 之间的 90 天结果没有差异。结论 在这项系统评价和荟萃分析中，与 MM 相比，EVT 与 BAO 患者的有利结果相关，死亡率降低长达 24 小时的卒中症状。NIHSS <10 的 BAO 患者的治疗效果不太确定。