Safety outcomes in endovascular treatment versus best medical management for basilar artery occlusion acute ischemic stroke: A systematic review and meta-analysis of randomized trials.
João Victor Sanders, Luma Maria Tavares de Sousa, Ocílio de Deus et al.
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In 30 seconds
This systematic review and meta-analysis pooled four randomized controlled trials comparing endovascular therapy (EVT) with best medical management (BMM) for acute ischemic stroke due to basilar artery occlusion. The trials included 988 patients: 556 treated with EVT and 432 with BMM. EVT was associated with higher risks of subarachnoid hemorrhage (RR 5.14; 95% CI [1.35-19.56]) and parenchymal hematoma type 2 (RR 5.53; 95% CI [1.47-20.84]). The analysis found no significant between-group differences in the other reported hemorrhagic or nonneurologic adverse events.
Key findings
- EVT was associated with increased subarachnoid hemorrhage risk versus BMM (RR 5.14; 95% CI [1.35-19.56]; I² = 0.0%).
- Parenchymal hematoma type 2 was more frequent with EVT (RR 5.53; 95% CI [1.47-20.84]; I² = 0.0%).
- No significant differences were observed for any parenchymal hematoma, type 1 hematoma, systemic/extracranial hemorrhage, pneumonia, or heart failure.
Why it matters
Safety assessment is important when weighing EVT for basilar artery occlusion, where the analysis identifies specific hemorrhagic complications that were more frequent with intervention. The absence of significant differences in several other adverse events provides a broader view of reported harms, while not establishing that those risks are equivalent between treatment groups.
What to keep in mind
The analysis included only four randomized trials, and confidence intervals for the increased hemorrhagic risks were wide.