Endovascular therapy (EVT) is 2.5 times more likely to achieve a positive outcome compared to standard medical management for vertebrobasilar stroke, which affects the back of the brain, including the brain stem. This finding comes from a meta-analysis of four randomized clinical trials published in The Lancet and led by Raul Nogueira, M.D., director of the UPMC Stroke Institute.
Impact on Vertebrobasilar Stroke
Vertebrobasilar artery occlusions, while representing a small percentage of all ischemic strokes, are particularly deadly. Without appropriate intervention, they can lead to severe disability and mortality rates exceeding 70%. The multi-center collaboration, VERITAS, aimed to provide more precise estimates of EVT benefits, focusing on specific patient subgroups.
Key Findings of the Meta-Analysis
The meta-analysis revealed that three months post-surgery, EVT significantly reduced patient mortality and overall post-stroke disability, despite higher rates of brain bleeds associated with the procedure. Patients who underwent EVT were nearly 2.5 times more likely to regain their ability to walk independently compared to those receiving standard medical care, including intravenous thrombolytics.
Expert Commentary
"While the overwhelming benefit of EVT for acute ischemic strokes due to occlusions of large vessels that supply the anterior brain has been well established, the benefit of this therapy for vertebrobasilar artery occlusion, one of the most devastating forms of stroke, has been more controversial," said Nogueira, professor of neurology and neurosurgery at the University of Pittsburgh. He added, "The results of the VERITAS collaboration are expected to influence treatment guidelines and impact stroke care globally. We hope that this analysis sets the foundation for improved recovery after vertebrobasilar strokes and helps more people regain their independence after this catastrophic medical event."
Study Details
The Pitt team, serving as the primary coordinating center, established common variables, definitions, and trial specifications, creating a core pooled dataset from the four randomized controlled clinical trials: ATTENTION, BAOCHE, BASICS, and BEST. The VERITAS collaboration is self-funded.
