Recanalization treatments in basilar artery occlusion-Systematic analysis

Area of Science:

• Neurology
• Interventional Neuroradiology
• Stroke Medicine

Background:

• Basilar artery occlusion (BAO) is a severe stroke type requiring revascularization.
• Current treatments include pharmacological thrombolysis and endovascular thrombectomy.
• The optimal approach and reasons for treatment futility remain unclear.

Purpose of the Study:

• To compare the effectiveness of endovascular mechanical interventions versus pharmacological thrombolysis for BAO.
• To identify predictors of futile recanalization in BAO treatment.

Main Methods:

• Systematic review and meta-analysis of 15 reports (2005 onwards) involving 803 patients.
• Analysis of a large single-center cohort (162 patients) to determine futility predictors.

Main Results:

• Mechanical approaches yielded better outcomes (35.5% vs. 24.4%) and recanalization rates (84.1% vs. 70.9%) than pharmacological thrombolysis.
• Primary thrombectomy achieved 91% recanalization and 36% good outcomes, but with a 60% futility rate (reduced to 52.8% with stentrievers).
• Extensive baseline ischemia was the strongest predictor of futile recanalization (OR 20-fold).

Conclusions:

• Endovascular mechanical methods offer superior outcomes for BAO compared to pharmacological thrombolysis.
• Improved patient selection, particularly avoiding those with extensive ischemia, is vital for enhancing clinical outcomes and reducing futility rates.