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

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). BAO accounts for 1% of the ischaemic strokes and 5%–10% of the LVO, but 70%–80% of BAO victims evolve to death or full dependence.2 3 The terminal nature of the brainstem and thalamic circulations may predispose to such dismal outcomes. 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. Thrombectomy RCTs designed for the enrollment of BAO-associated stroke patients were eligible for inclusion. The only exclusion criterion was …