Zhubi Esra, Bissenov Azamat, Engh Marie Anne, Tóth Réka, Horváth András Attila, Hegyi Peter, Gunda Bence
Department of Neurology, Semmelweis University, Balassa utca 6, Budapest, H-1083, Hungary.
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Geroscience. 2025 Sep 18. doi: 10.1007/s11357-025-01887-0.
The benefits and safety of bridging therapy in basilar artery occlusion remain unclear, although current guidelines recommend it based on weak evidence and analogy to anterior circulation strokes. This study compares bridging intravenous thrombolysis and endovascular thrombectomy versus direct endovascular thrombectomy in a larger-than-ever basilar artery occlusion Population. Embase, PubMed, Scopus, Web of Science, and Cochrane Library were systematically searched. Studies that reported 90-day functional independence (mRS: 0-2), 90-day independent ambulation (mRS: 0-3), successful recanalization, symptomatic intracranial hemorrhage, any type of intracranial hemorrhage, and 90-day mortality were included. Two reviewers independently extracted data and assessed bias using ROBINS-I. A random-effects model was used. The protocol was registered in PROSPERO (CRD42024519161). Fifty-eight studies with 9372 subjects were included in the final analysis. Bridging therapy was associated with higher 90-day functional independence (OR 1.46; 95% CI 1.22-1.76; p < 0.001) and lower 90-day mortality (OR 0.63; 95% CI 0.49-0.82; p = 0.002). No significant differences were found in recanalization rate (OR 0.97; 95% CI 0.79-1.18; p = 0.707) or symptomatic intracranial hemorrhage (OR 0.88; 95% CI 0.65-1.18; p = 0.330). Benefits were consistent across subgroups defined by stroke severity, treatment window, occlusion site, and study site. Bridging therapy for basilar artery occlusion patients leads to a higher rate of functional independence and lower mortality without increasing the rate of intracranial hemorrhage compared to direct endovascular thrombectomy consistently across all subgroups.
尽管目前的指南基于薄弱的证据并类比前循环卒中推荐桥接治疗，但基底动脉闭塞患者进行桥接治疗的获益和安全性仍不明确。本研究在比以往更大的基底动脉闭塞患者群体中比较了桥接静脉溶栓和血管内血栓切除术与直接血管内血栓切除术的效果。系统检索了Embase、PubMed、Scopus、Web of Science和Cochrane图书馆。纳入报告了90天功能独立性（改良Rankin量表：0 - 2）、90天独立行走能力（改良Rankin量表：0 - 3）、成功再通、症状性颅内出血、任何类型的颅内出血以及90天死亡率的研究。两名研究者独立提取数据并使用ROBINS - I评估偏倚。采用随机效应模型。该方案已在PROSPERO（CRD42024519161）注册。最终分析纳入了58项研究，共9372名受试者。桥接治疗与更高的90天功能独立性（比值比1.46；95%置信区间1.22 - 1.76；p < 0.001）和更低的90天死亡率（比值比0.63；95%置信区间0.49 - 0.82；p = 0.002）相关。在再通率（比值比0.97；95%置信区间0.79 - 1.18；p = 0.707）或症状性颅内出血（比值比0.88；95%置信区间0.65 - 1.18；p = 0.330）方面未发现显著差异。在根据卒中严重程度、治疗窗、闭塞部位和研究地点定义的亚组中，获益情况一致。与直接血管内血栓切除术相比，基底动脉闭塞患者的桥接治疗在所有亚组中均能带来更高的功能独立性率和更低的死亡率，且不增加颅内出血率。
