Endovascular therapy for basilar occlusion: Is there robust evidence?

with acute basilar artery occlusion is as high as 90% [1,2]. Observational studies report that with revascularization therapies this rate decreases by about 75% [2,3]. To this regard, four randomized trials were carried out to investigate the association between revascularization therapy and any benefit in patients with basilar artery occlusion and their results were recently published [4–7]. The meta-analysis by Lin et al. [8], published in this issue of the Journal, includes the results of these trials with a total of 988 patients (12 with bilateral vertebral occlusion) and concludes that, in patients with acute basilar occlusion, endovascular therapy, compared with best medical management, might be associated with significant increased rates of ambulation, independence and survival, but also with an increased risk of symptomatic intracranial hemorrhage. However, as correctly stated by the Authors, the pooled results of this meta-analysis can only be considered as a preliminary suggestion rather than clinical guidance as they are not supported by robust evidence.