Abstract T MP25: Recanalization of Acute Basilar Artery Occlusion Improves Mortality and Functional Outcome: A Meta-Analysis
Background and purpose: Randomized trial data supporting/refuting recanalization are sparse in acute basilar artery occlusion (BAO) with only one small RCT in literature. There is a wealth of data in the form of observational case series spanning several decades. We sought to synthesize outcome and mortality estimates from the available studies on acute BAO.
Methods: MEDLINE, EMBASE, The Cochrane Library, and clinicaltrials.gov were searched with keywords “acute ischemic stroke” and “basilar artery occlusion”. Heterogeneity was calculated using Cochran Q (Q>df; p<0.5- significant), I2 and tau2. Dersimonian and Laird random-effects model was used to synthesize data. Pooled estimates were expressed as odds ratio (OR) and 95% CI. MIX Pro 2.0 was used for all analyses.
Results: Thirty-seven studies provided mortality data (n= 1784), while 35 provided poor outcome data (n = 1755). In mortality synthesis, heterogeneity was significant (Q = 49.18, p = 0.07). Figure 1 shows OR for mortality with recanalization. ARR was 42.3% and NNT = 2.4. Subgroup analysis, separating IV TPA and IA therapy, revealed comparable ORs but heterogeneity was significant. In synthesis of poor outcome heterogeneity was not significant. Figure 2 shows OR for poor outcome with recanalization. ARR=35.3% and NNT=2.8. Subgroup analysis between IV TPA and IA therapy revealed comparable pooled ORs but significant heterogeneity in synthesis for IV TPA.
Conclusion: Recanalization reduces mortality and poor outcome in BAO by OR of 0.19 and 0.20. These data do not support the notion that IA/mechanical intervention is superior to IV tPA since this effect persists when data are analyzed in each of these subgroups.
Author Disclosures: G. Kumar: None. A.V. Alexandrov: Ownership Interest; Significant; Cerevast Therapeutics. Consultant/Advisory Board; Significant; Cerevast Therapeutics.
- © 2014 by American Heart Association, Inc.