Research Fellow Lenox Hill Hospital/Northwell Health
Introduction: Basilar artery occlusion (BAO) is a life-threatening condition with high rates of mortality and severe disability. Endovascular therapy, including angioplasty, has emerged as a potential treatment strategy. However, the efficacy and safety of angioplasty for BAO in acute ischemic stroke (AIS) remains uncertain. This systematic review and single-arm meta-analysis aimed to evaluate the efficacy and safety of angioplasty for BAO in AIS.
Methods: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. Studies evaluating the use of angioplasty for BAS in AIS were included. Outcomes of interest were successful reperfusion at 90 days as per Modified Treatment In Cerebral Ischemia (mTICI) scale; post-operative complications; 90-day functional independence measured by the Modified Rankin Score (mRS); and mortality rate at 90 days post-intervention. Meta-analyses were performed using random-effects models to calculate proportions with 95% confidence intervals (CIs). Heterogeneity was assessed with I².
Results: Fourteen observational studies involving 849 patients were analyzed. Participants had a mean age of 66.5 years, with 67.7% being male. Successful reperfusion as per mTICI scale was achieved in 84% of patients (95% CI 0.75-0.93; I²=86%), but 36% experienced postoperative complications (95% CI 0.19-0.53; I²=98%). At 90 days post-intervention, 39% of patients achieved functional independence (mRS) (95% CI 0.30-0.47; I²=66%), while the overall mortality rate was 24% (95% CI 0.16-0.32; I²=95%).
Conclusion : Our findings suggest that angioplasty for BAO in AIS can achieve high rates of successful reperfusion and functional independence. However, it is associated with significant rates of postoperative complications and mortality. Large-scale, well-designed randomized controlled trials are necessary to definitively establish the efficacy and safety of this intervention and optimize patient outcomes.
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