Background
Methods
Protocol and guidance
Population | Acute ischemic stroke due to basilar artery occlusion. |
Intervention | Mechanical thrombectomy and best medical therapy. |
Comparison | Best medical therapy only. |
Outcome | Good neurological outcome defined as a modified Rankin Scale (mRS) of ≤3 at day 90. Secondary outcomes included mortality, symptomatic intracranial hemorrhage (sICH) and functional independence (mRS ≤2). |
Literature search and data extraction
Risk of bias
Statistical analysis
Results of the search
Included studies
Trial | Definition of sICH |
---|---|
BASICS | Heidelberg Bleeding Classification - haemorrhagic transformation of infarcted brain tissue, intracerebral haemorrhage both within and outside infarcted brain tissue, intracerebral haemorrhage outside the infarcted brain tissue, or intracranial–extracerebral haemorrhage and an increase of 4 points or more in the NIHSS score or an increase of 2 points or more in 1 of the 11 NIHSS subcategories. |
BEST | SITS-MOST criteria - evidence of intracranial haemorrhage on imaging and an increase of 4 or more points on the NIHSS within 24 h after randomisation. |
ATTENTION | SITS-MOST criteria - evidence of intracranial haemorrhage on imaging and an increase of 4 or more points on the NIHSS. |
BAOCHE | SITS-MOST criteria - evidence of intracranial haemorrhage on imaging and an increase of 4 or more points on the NIHSS. |
Characteristics of included trials
BASICS | BEST | ATTENTION | BAOCHE | |
---|---|---|---|---|
Date | 2011–2019 | 2015–2017 | 2021–2022 | 2016–2022 |
Symptom onset to inclusion (hours) | 0–6 | 0–8 | 0–12 | 6–24 |
Number screened | 424 | 288 | 507 | Data not available |
Number of participants | 300 | 131 | 340 | 217 |
Crossover (percentage) | 3/154 (1.9) to BMT 7/146 (4.7) to MT | 3/66 (4.5) to BMT 14/65 (21.5) to MT | 3/226 (1.3) to BMT 3/114 (2.6) to MT | 1/110 (0.9) to BMT 4/107 (3.7) to MT |
Median NIHSS at presentation (IQR) | Intervention: 21.9 Control: 22.1 (IQR not available) | Intervention: 32 (18–38) Control: 26 (13–37) | Intervention: 24 (15–35) Control: 24 (14–35) | Intervention: 20 (14.5–29) Control: 19 (12–30) |
Intravenous thrombolysis (%) | Intervention: 121/154 (78.6) Control: 116/146 (79.5) | Intervention: 18/66 (27) Control: 21/65 (32) | Intervention: 69/226 (30.5) Control: 39/114 (34.2) | Intervention: 15/110 (13.6) Control: 23/107 (21.5) |
Blinding | Open-label, blinded outcome assessment | Open-label, blinded outcome assessment | Open-label, blinded outcome assessment | Open-label, blinded outcome assessment |
mRS (≤3) (percentage) | Intervention: 68/154 (44.1) Control: 55/146 (37.6) | Intervention: 28/66 (42.4) Control: 21/65 (32.3) | Intervention: 104/226 (46) Control: 26/114 (22.8) | Intervention: 51/110 (46.3) Control: 26/107 (24.2) |
Mortality at day 90 (percentage) | Intervention: 59 (38.3) Control: 63 (43.2) | Intervention: 22 (33.3) Control: 25 (38.4) | Intervention: 83 (36.7) Control: 63 (55.2) | Intervention: 34 (30.9) Control: 45 (42.1) |
sICH (percentage) | Intervention: 6 (4.5) Control: 1 (0.7) | Intervention: 5 (8) Control: 0 | Intervention: 12 (5) Control: 0 | Intervention: 6 (8.8) Control: 1 (2.3) |
Follow up: | 24 hrs, 90 days | 24 hrs, 90 days | 24 hrs, 90 days | 24 hrs, 90 days, 6 months, 1 year |