Naunyn Schmiedebergs Arch Pharmacol. 2025 Aug 1. doi: 10.1007/s00210-025-04482-4. Online ahead of print.
ABSTRACT
Acute basilar artery occlusion (BAO) is a rare but devastating type of ischemic stroke that significantly impacts outcomes. This systematic review and meta-analysis aim to evaluate the efficacy and safety of combining IVT with EVT (EVT + IVT) versus EVT alone in treating acute BAO, focusing on functional independence, mortality, reperfusion success, and hemorrhagic and procedural complications. We conducted a comprehensive search up to May 2025. Effect sizes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs), and statistical significance was determined using p-values. Risk of bias was assessed using the ROBINS-I tool, and certainty of evidence was rated via the GRADE framework. Eight observational studies comprising 5252 patients (1777 EVT + IVT and 3475 EVT alone) were included. The analysis revealed that EVT + IVT showed higher odds of functional independence (mRS 0-2) compared to EVT alone, with an odds ratio of 1.23 (95% CI 1.06-1.43, p = 0.0080). Additionally, EVT + IVT significantly reduced mortality, with an odds ratio of 0.81 (95% CI 0.68-0.96, p = 0.0141). No significant differences were observed in symptomatic intracerebral hemorrhage, subarachnoid hemorrhage, reperfusion success (mTICI 2b/3), or procedural complications. This meta-analysis demonstrates that EVT + IVT is associated with improved functional independence and reduced mortality in acute BAO compared to EVT alone, without increasing the risk of hemorrhagic or procedural complications. These results are, however, based on very low certainty evidence. While bridging therapy appears to provide clinical benefits, high-quality randomized trials are urgently needed to confirm these findings and refine treatment protocols for posterior circulation strokes.
PMID:40748475 | DOI:10.1007/s00210-025-04482-4
