Endovascular treatment for basilar artery occlusion: A Bayesian network meta-analysis comparing time-to-treatment windows and medical management.
Lucca Tamara Alves Carretta, Ocilio Ribeiro Gonçalves, Luciano Falcão et al.
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In 30 seconds
This Bayesian random-effects network meta-analysis compared endovascular treatment (EVT) with best medical therapy (BMT) for basilar artery occlusion, examining treatment within 0–6 hours and beyond 6 hours. It included randomized, prospective, and retrospective studies; seven studies with 4,125 patients were analyzed. EVT was associated with better functional outcomes than BMT in both time windows, with the late window having a higher probability of favorable modified Rankin Scale scores (0–2). Mortality reduction was inconsistent, while hemorrhagic and overall complications were more frequent with EVT.
Key findings
- Across both treatment windows, EVT showed superior functional outcomes compared with BMT.
- EVT beyond 6 hours had a higher probability of favorable mRS scores (0–2) than earlier treatment.
- Mortality reduction with EVT was inconsistent.
- Both early and late EVT were associated with higher risks of hemorrhagic and overall complications.
Why it matters
The analysis suggests that treatment timing alone may not define the potential benefit of EVT for basilar artery occlusion. Functional outcomes favored EVT in both windows, but the accompanying complication risks and inconsistent mortality findings make patient selection important. The results support considering clinical and imaging features when weighing potential benefit against harm.
What to keep in mind
The analysis combined randomized trials with prospective and retrospective studies, so the evidence includes nonrandomized comparisons. The abstract does not report study-level risk of bias or detailed estimates of effect.