Is more evidence needed for thrombectomy in basilar artery occlusion? The BASICS and BEST meta-analytical approaches

• Published in: Stroke and vascular neurology Vol. 6; no. 4; pp. 671 - 672
• Main Authors: Solla, Davi J Fontoura, Argolo, Felipe Coelho, Budohoski, Karol P, Kolias, Angelos G, Caldas, José Guilherme M P, Oliveira-Filho, Jamary
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01-12-2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Arterial Occlusive Diseases; artery; Basilar Artery; Humans; International cooperation; Ischemia; Letter; Meta-analysis; Patients; statistics; Stroke; thrombectomy; Thrombectomy - adverse effects; Veins & arteries; artery; stroke; thrombectomy; statistics
• ISSN: 2059-8688; 2059-8696
• DOI: 10.1136/svn-2020-000701

Correspondence to Dr Davi J Fontoura Solla; [e-mail] Introduction The benefit of mechanical thrombectomy for stroke associated with anterior circulation large vessel occlusion (LVO) is well established and among the most effective treatments in medicine.1 Stroke associated with basilar artery occlusion (BAO) was not included in the seminal thrombectomy randomised clinical trials (RCTs). Only two RCT designed to assess the efficacy of early (<6–8 hours since symptoms onset) thrombectomy for BAO treatment, the BEST and BASICS trials.2 4 Given the prior evidence for thrombectomy benefit for anterior circulation stroke is well settled; BAO stroke shares a similar physiopathology with very poor prognosis; the two available BAO trials had limited sample sizes but large absolute differences on the functional outcomes; we propose that an aggregated analysis of the BEST and BASICS trials should be performed under a Bayesian approach. A Bayesian random-effects meta-analysis was modelled with a prior choice of µ effect parameter based on the results of the HERMES collaboration, in which thrombectomy was associated with a higher odd of modified Rankin Score (mRS) 0–3 at 90 days (OR 2.25, 95% CI 1.80 to 2.82).1 Thus, a Gaussian prior with mean 0.811 (2.25 in the logarithmic OR scale) and SD 0.414 (percentile 2.5 corresponding to the null effect, since a prior hypothesis of a thrombectomy deleterious effect was highly unlikely) was appropriate (online supplemental figure 1).