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

## TL;DR

This study finds that combining clot-busting drugs with a mechanical procedure improves outcomes for severe strokes in the brainstem without increasing risks.

## Contribution

The study provides the first comprehensive meta-analysis comparing bridging therapy and endovascular thrombectomy for acute basilar artery occlusion.

## Key findings

- Bridging therapy improves functional independence and reduces mortality in BAO patients.
- Bridging therapy does not increase the risk of intracranial hemorrhage compared to endovascular thrombectomy alone.
- Recanalization success rates are similar between bridging therapy and endovascular thrombectomy alone.

## Abstract

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.

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.

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; I
2 = 23%) and independent ambulation (mRS ≤ 3) (RR = 1.10; 95%CI: [1.01, 1.20]; p = 0.02; I
2 = 0%). The mortality risk was also significantly lower in bridging therapy (RR = 0.83; 95%CI: [0.75, 0.93]; p = 0.001; I
2 = 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; I
2 = 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; I
2 = 0%).

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.

The meta‐analysis compares bridging therapy to endovascular thrombectomy in acute basilar artery occlusion, finding that EVT+IVT provides significant functional benefits, lowers mortality risk, and does not increase hemorrhage risk compared to EVT alone, with similar recanalization success rates for both treatments.