Abstract：
OBJECTIVE: This study aimed to summarize the clinical outcomes of endovascular treatment in patients with basilar artery occlusion (BAO) with different pathologic mechanisms.
METHODS: Two independent reviewers searched PubMed/MEDLINE, Embase and Cochrane Library database up to December 2022, patients with different BAO pathological mechanisms (BAO with in situ atherosclerosis vs. embolism alone without vertebral artery steno-occlusion vs. embolism from tandem vertebral artery steno-occlusion) were collected and analyzed. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) to assess the associations between clinical outcomes and BAO pathological mechanisms.
RESULTS: A total of 1163 participants from 12 studies were identified. Compared with embolism alone, patients with in situ atherosclerotic BAO had a lower favorable outcome rate (modified Rankin score [mRS] 0-2: 34.5% vs. 41.2%; OR 0.83, 95% CI 0.70-0.98; P = 0.03) and moderate outcome rate (mRS 0-3: 45.8% vs. 55.4%; OR 0.65, 95% CI 0.47-0.90; P = 0.01) at 3 months and a higher risk of mortality (29.9% vs. 27.2%; OR 1.31, 95% CI 0.96-1.79, P = 0.09; adjusted OR 1.46, 95% CI 1.08-1.96). Tandem BAO had a comparable mortality risk to that of in situ atherosclerotic BAO (OR 1.37, 95% CI 0.84-2.22; P = 0.48) or embolism alone (OR 1.44, 95% CI 0.65-3.21; P = 0.43), and there were no significant differences in favorable or moderate outcomes between tandem BAO and each of the other two BAO mechanisms.
CONCLUSIONS: Among BAO patients with endovascular treatment, embolism mechanism had better clinical outcomes than in situ atherosclerosis, and atherosclerotic mechanism was associated with a higher mortality at 3 months. RCTs are needed to further confirm clinical outcomes of BAO by different mechanisms.
METHODS: Two independent reviewers searched PubMed/MEDLINE, Embase and Cochrane Library database up to December 2022, patients with different BAO pathological mechanisms (BAO with in situ atherosclerosis vs. embolism alone without vertebral artery steno-occlusion vs. embolism from tandem vertebral artery steno-occlusion) were collected and analyzed. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) to assess the associations between clinical outcomes and BAO pathological mechanisms.
RESULTS: A total of 1163 participants from 12 studies were identified. Compared with embolism alone, patients with in situ atherosclerotic BAO had a lower favorable outcome rate (modified Rankin score [mRS] 0-2: 34.5% vs. 41.2%; OR 0.83, 95% CI 0.70-0.98; P = 0.03) and moderate outcome rate (mRS 0-3: 45.8% vs. 55.4%; OR 0.65, 95% CI 0.47-0.90; P = 0.01) at 3 months and a higher risk of mortality (29.9% vs. 27.2%; OR 1.31, 95% CI 0.96-1.79, P = 0.09; adjusted OR 1.46, 95% CI 1.08-1.96). Tandem BAO had a comparable mortality risk to that of in situ atherosclerotic BAO (OR 1.37, 95% CI 0.84-2.22; P = 0.48) or embolism alone (OR 1.44, 95% CI 0.65-3.21; P = 0.43), and there were no significant differences in favorable or moderate outcomes between tandem BAO and each of the other two BAO mechanisms.
CONCLUSIONS: Among BAO patients with endovascular treatment, embolism mechanism had better clinical outcomes than in situ atherosclerosis, and atherosclerotic mechanism was associated with a higher mortality at 3 months. RCTs are needed to further confirm clinical outcomes of BAO by different mechanisms.
摘要：
目的：本研究旨在总结不同病理机制的基底动脉闭塞（BAO）患者腔内治疗的临床效果。
方法：两名独立的审阅者搜索了PubMed/MEDLINE，截至2022年12月的Embase和CochraneLibrary数据库，具有不同BAO病理机制的患者（BAO与原位动脉粥样硬化vs.无椎动脉狭窄闭塞的单纯栓塞与收集并分析了来自串联椎动脉狭窄闭塞的栓塞）。我们计算了比值比（ORs）和95％置信区间（CIs），以评估临床结果与BAO病理机制之间的关联。
结果：共确定了来自12项研究的1163名参与者。与单纯栓塞相比，原位动脉粥样硬化BAO患者的有利转归率较低(改良Rankin评分[mRS]0-2：34.5%vs.41.2%；OR0.83，95%CI0.70-0.98；P=0.03）和中度结局率（mRS0-3：45.8%vs.55.4％；OR0.65，95％CI0.47-0.90；P=0.01）在3个月和更高的死亡率风险（29.9％vs.27.2%；OR1.31，95%CI0.96-1.79，P=0.09；调整后OR1.46，95%CI1.08-1.96）。串联BAO与原位动脉粥样硬化性BAO（OR1.37，95％CI0.84-2.22；P=0.48）或单独栓塞（OR1.44，95％CI0.65-3.21；P=0.43）的死亡风险相当，串联BAO与其他两种BAO机制在有利或中度结局方面无显着差异。
结论：在接受血管内治疗的BAO患者中，栓塞机制比原位动脉粥样硬化有更好的临床结果，动脉粥样硬化机制与3个月时较高的死亡率相关。需要通过不同机制进一步证实BAO的临床结局。
方法：两名独立的审阅者搜索了PubMed/MEDLINE，截至2022年12月的Embase和CochraneLibrary数据库，具有不同BAO病理机制的患者（BAO与原位动脉粥样硬化vs.无椎动脉狭窄闭塞的单纯栓塞与收集并分析了来自串联椎动脉狭窄闭塞的栓塞）。我们计算了比值比（ORs）和95％置信区间（CIs），以评估临床结果与BAO病理机制之间的关联。
结果：共确定了来自12项研究的1163名参与者。与单纯栓塞相比，原位动脉粥样硬化BAO患者的有利转归率较低(改良Rankin评分[mRS]0-2：34.5%vs.41.2%；OR0.83，95%CI0.70-0.98；P=0.03）和中度结局率（mRS0-3：45.8%vs.55.4％；OR0.65，95％CI0.47-0.90；P=0.01）在3个月和更高的死亡率风险（29.9％vs.27.2%；OR1.31，95%CI0.96-1.79，P=0.09；调整后OR1.46，95%CI1.08-1.96）。串联BAO与原位动脉粥样硬化性BAO（OR1.37，95％CI0.84-2.22；P=0.48）或单独栓塞（OR1.44，95％CI0.65-3.21；P=0.43）的死亡风险相当，串联BAO与其他两种BAO机制在有利或中度结局方面无显着差异。
结论：在接受血管内治疗的BAO患者中，栓塞机制比原位动脉粥样硬化有更好的临床结果，动脉粥样硬化机制与3个月时较高的死亡率相关。需要通过不同机制进一步证实BAO的临床结局。
