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Revascularization of vertebrobasilar tandem occlusions: a meta-analysis

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Abstract

Purpose

To investigate the difference in mechanical thrombectomy (MT) outcomes between vertebrobasilar tandem occlusion (VBTO) and isolated basilar artery (BA) occlusion (non-VBTO) and the difference in rates of successful recanalization between the clean-road and dirty-road pathways, in VBTO.

Methods

We conducted a meta-analysis after searching PubMed, EMBASE, and Google Scholar databases as of April 2021. We only included adult patients who underwent MT to treat acute ischemic stroke (AIS) due to VBTO, and the following outcomes should be reported: successful recanalization, functional outcome at 90 days, and symptomatic intracerebral hemorrhage (sICH). The main effect size measures were odds ratio and risk difference, and the software used was RevMan 5.4.

Results

The analysis included 81 VBTO and 324 non-VBTO patients (seven studies). We found no significant difference regarding 3 m functional independence [4 studies: OR = 1.71 (95% CI, 0.54, 5.43), I2 = 75%], 3 m mortality [4 studies: OR = 1.62 (95% CI, 0.62, 4.25), I2 = 66%], sICH [4 studies: OR = 1.71 (95% CI, 0.67, 4.39), I2 = 0%], and successful recanalization [3 studies: OR = 0.81 (95% CI, 0.12, 5.57), I2 = 80%]. A subgroup analysis of 118 VBTO patients (five studies) showed no significant difference in successful recanalization between clean-road and dirty-road pathways [RD = 0.07 (95% CI, − 0.09, 0.24), I2 = 40%].

Conclusion

The results of this meta-analysis support the use of MT for AIS patients with VBTO. In VBTO patients, none of the clean-road or dirty-road pathways proved to be superior to the other.

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Availability of data and material (data transparency)

All data and materials included in this study comply with field standards.

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Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shebin El-kom, Menoufia, Egypt

    Mohamed Nabil Mahmoud

  2. Department of Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt

    Mohamed M. A. Zaitoun

  3. Neurosurgery Department, St George’s University Hospital, Blackshaw Road, London, UK

    Mohamed A. Abdalla

Authors
  1. Mohamed Nabil Mahmoud
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  2. Mohamed M. A. Zaitoun
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  3. Mohamed A. Abdalla
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Contributions

Mohamed N. Mahmoud Idea of the meta-analysis – searching the literature– records filtration according to PRISMA guidelines–evaluation of the methodological quality of the selected observational studies—Writing the manuscript draft

Mohamed M.A. Zaitoun searching the literature – records filtration according to PRISMA guidelines – evaluation of the methodological quality of the selected observational studies – revision of the manuscript draft

Mohamed A. Abdalla Solving discrepancies between the two other others regarding study selection/exclusion and the assessment of quality of selected studies –Revision of language – revision of the manuscript draft

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Correspondence to Mohamed Nabil Mahmoud.

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Mahmoud, M.N., Zaitoun, M.M.A. & Abdalla, M.A. Revascularization of vertebrobasilar tandem occlusions: a meta-analysis. Neuroradiology 64, 637–645 (2022). https://doi.org/10.1007/s00234-021-02866-w

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