LAUSR

BACKGROUND Mechanical thrombectomy (MT) for anterior circulation stroke has been proven to be highly effective. In comparison, MT for basilar artery occlusion (BAO) continues to lack definitive evidence of efficacy. The main MT modalities are stent retriever (SR) and direct aspiration (DA). Several studies have recently been published comparing the two approaches. OBJECTIVE To directly compare and synthesize safety and efficacy outcomes with SR versus DA for acute BAO. METHODS A systematic review and meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Overall, eight studies comprising 693 patients with BAO were included (SR: 457; DA: 236). The SR group was associated with statistically significant lower odds of modified Thrombolysis in Cerebral Infarction (mTICI)2b/3 (OR: 0.54; 95%CI: 0.31-0.94) and mTICI3 (OR: 0.47; 95%CI: 0.23-0.95) compared to DA. Favorable outcome rates, were similar between the two groups (OR:0.83; 95%CI: 0.60-1.16). The rates of symptomatic ICH (sICH) (OR: 3.57; 95%CI: 0.75-16.95), subarachnoid hemorrhage (SAH) (OR:4.71; 95%CI: 0.82-26.90) and vessel perforation (OR: 2.64; 95%CI:0.43-16.33) were higher in the SR group, but statistical significance was not reached. The rates of 90-day mortality were similar between the two groups (OR:1.07; 95%CI: 0.67-1.70). Procedure duration was significantly shorter when DA was used compared to SR (Weighted mean difference: 26.10 minutes; 95% CI:13.28-38.92). CONCLUSIONS SR is associated with statistically significant lower odds of mTICI 2b/3 and mTICI 3 recanalization rates compared to DA. SR appears to be associated with a higher complication rates but significance was not reached.