Intra-arterial revascularization therapy for basilar artery occlusion—a systematic review and analysis

Acute basilar artery occlusion has been managed aggressively with various modalities due to its potentially debilitating outcome. While intra-arterial mechanical thrombectomy with stentriever has established clear evidence for anterior circulation stroke with large vessel occlusion as an adjunct to intravenous thrombolysis or the sole modality in intravenous thrombolysis ineligible patients, similar high-level evidence was not available for intra-arterial mechanical thrombectomy of posterior circulation stroke with acute basilar artery occlusion. We hence perform a systematic review of current literature to compare intra-arterial pharmacological thrombolysis (IA-P) and intra-arterial mechanical thrombectomy (IA-MT) for acute basilar artery occlusion. Forty-one studies published between 1996 and 2015 were compared and studied by odds ratio analysis using Mantel-Haenszel risk ratio estimation, and time trend analysis using meta-regression. Patients in the IA-MT group were older, presented with more severe stroke, and more likely received treatment more than 12 h since onset of stroke. At 3 months, survival and clinical outcome were superior in the IA-MT group than the IA-P group, associated with higher recanalization rate. There were no difference between proportion of dependent survivors, and rate of symptomatic intracerebral hemorrhage across groups. Intra-arterial thrombolysis with mechanical devices led to improved survival, better short-term clinical outcome and higher recanalization rate than intra-arterial pharmacological thrombolysis.