Comparing Efficacy and Safety of Bridging Therapy Versus Endovascular Thrombectomy in Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis.

Abstract

<h4>Background</h4>Basilar artery occlusion (BAO), a rare and severe stroke, causes high morbidity and mortality. This meta-analysis aims to compare bridging therapy, including endovascular thrombectomy (EVT) with intravenous thrombolysis (IVT), versus EVT alone in BAO.<h4>Methods</h4>PubMed, Cochrane Central, and ScienceDirect were searched until May 2025. The risk ratios (RRs) and 95% confidence intervals (CIs) were combined using a random effects model in Review Manager software. The quality assessment was conducted using the Cochrane Risk of Bias (RoB 2.0) and the Newcastle-Ottawa scale. Publication bias was assessed visually via funnel plots and statistically using Egger's regression test. This review's protocol was registered on PROSPERO with the ID: CRD420251108752.<h4>Results</h4>A total of 14 studies, including 11 observational studies and 3 randomized controlled trials, with 3745 participants, were analyzed. Bridging therapy was associated with a significantly higher likelihood of achieving functional independence (modified Rankin Scale (mRS) ≤ 2) (RR = 1.27; 95%CI: [1.13, 1.43]; p < 0.0001; I² = 23%) and independent ambulation (mRS ≤ 3) (RR = 1.10; 95%CI: [1.01, 1.20]; p = 0.02; I² = 0%). The mortality risk was also significantly lower in bridging therapy (RR = 0.83; 95%CI: [0.75, 0.93]; p = 0.001; I² = 0%). The successful recanalization endpoint was found to be comparable between the bridging therapy and EVT alone arms (RR = 1.00; 95%CI: [0.97, 1.03]; p = 0.99; I² = 0%). Similarly, there was no significant difference between the intervention and control groups in spontaneous intracranial hemorrhage (sICH) (RR = 0.99; 95%CI: [0.71, 1.39]; p = 0.97; I² = 0%).<h4>Conclusion</h4>Our meta-analysis supports administering IVT before EVT for BAO, showing benefits in functional outcomes and mortality without increasing hemorrhage risk, although successful recanalization was similar in both groups.