Departments of1Interventional Neuroradiology and.
2China National Clinical Research Center for Neurological Diseases, Beijing, China.
J Neurosurg. 2023 Feb 3;139(3):732-740. doi: 10.3171/2022.12.JNS222490. Print 2023 Sep 1.
Acute ischemic stroke caused by basilar artery occlusion (BAO) is devastating, but the optimal treatment for patients with BAO remains controversial. In this study, the authors aimed to investigate the safety and efficacy of endovascular treatment (ET) versus standard medical treatment (SMT) in patients with BAO.
The PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs). The primary outcome was good functional outcome, defined as a modified Rankin Scale (mRS) score of 0-3 at 90 days. The secondary efficacy outcome was excellent functional outcome defined as an mRS score of 0-2 at 90 days. The safety outcomes included mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Subgroup analyses were carried out based on race (Asian or non-Asian).
Four RCTs of 988 patients (556 in the ET group and 432 in the SMT group) were included in this meta-analysis. The proportion of good functional outcome in the ET group was significantly higher than that in the SMT group (45.1% vs 29.6%; number needed to treat 6.45; RR 1.54, 95% CI 1.16-2.06; p = 0.003, I2 = 60%). The subgroup analysis based on race showed a significant difference between Asian and non-Asian race in the primary outcome (p = 0.03, I2 = 78.5%). Patients in the ET group had a higher rate of excellent functional outcome at 90 days than those in the SMT group (34.9% vs 20.6%; RR 1.83, 95% CI 1.07-3.12; p = 0.03, I2 = 80%). Patients in the ET group had a lower mortality at 90 days (35.6% vs 45.4%; RR 0.77, 95% CI 0.66-0.89; p = 0.0007, I2 = 0%) but a higher rate of sICH (5.4% vs 0.5%; RR 8.29, 95% CI 2.49-27.66; p = 0.0006, I2 = 0%) than those in the SMT group.
ET may improve the functional outcome and reduce mortality at 90 days but increase the risk of sICH compared with SMT in patients with BAO. This conclusion needs to be confirmed in non-Asian populations in future studies. Systematic review registration no.: CRD42022357718 (https://www.crd.york.ac.uk/prospero/).
基底动脉闭塞（BAO）引起的急性缺血性脑卒中危害极大，但 BAO 患者的最佳治疗方法仍存在争议。本研究旨在探讨血管内治疗（ET）与标准药物治疗（SMT）在 BAO 患者中的安全性和疗效。
检索 PubMed、Embase 和 Cochrane Library 数据库中的随机对照试验（RCT）。主要结局为 90 天时的良好功能结局，定义为改良 Rankin 量表（mRS）评分为 0-3 分。次要疗效结局为 90 天时的优秀功能结局，定义为 mRS 评分为 0-2 分。安全性结局包括 90 天时的死亡率和症状性颅内出血（sICH）。根据种族（亚洲或非亚洲）进行亚组分析。
本荟萃分析纳入了 4 项 RCT 共 988 例患者（ET 组 556 例，SMT 组 432 例）。ET 组的良好功能结局比例明显高于 SMT 组（45.1% vs 29.6%；需要治疗的人数 6.45；RR 1.54，95%CI 1.16-2.06；p = 0.003，I2 = 60%）。基于种族的亚组分析显示，主要结局在亚洲和非亚洲人群之间存在显著差异（p = 0.03，I2 = 78.5%）。ET 组 90 天时的优秀功能结局发生率高于 SMT 组（34.9% vs 20.6%；RR 1.83，95%CI 1.07-3.12；p = 0.03，I2 = 80%）。ET 组 90 天时的死亡率较低（35.6% vs 45.4%；RR 0.77，95%CI 0.66-0.89；p = 0.0007，I2 = 0%），但 sICH 发生率较高（5.4% vs 0.5%；RR 8.29，95%CI 2.49-27.66；p = 0.0006，I2 = 0%）。
与 SMT 相比，ET 可能改善 BAO 患者 90 天时的功能结局并降低死亡率，但增加 sICH 的风险。这一结论需要在未来的非亚洲人群研究中得到证实。系统评价注册号：CRD42022357718（https://www.crd.york.ac.uk/prospero/）。
