Endovascular thrombectomy versus best medical therapy for acute vertebrobasilar artery occlusion in patients with low NIHSS scores: a meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Adjusted OR 2.86 (95% CI 1.89-4.31) favoring EVT

• Primary Outcome: 90-day excellent functional outcome (mRS 0-1)

• Nnt Or Sensitivity: Number needed to treat not calculable from available data

• Confidence Interval: 95% CI 1.89-4.31

Clinical Application

Requires comprehensive stroke centers with 24/7 endovascular capabilities and experienced neurointerventionalists Relevant to Australian comprehensive stroke centers; aligns with current Stroke Foundation guidelines emphasizing endovascular therapy, though evidence base remains observational Patients with acute vertebrobasilar occlusion and mild symptoms (NIHSS ≤10) presenting within treatment window

Abstract

OBJECTIVE: The efficacy of endovascular thrombectomy (EVT) for acute vertebrobasilar artery occlusion (VBAO) presenting with mild symptoms (National Institutes of Health Stroke Scale [NIHSS] score ≤10) remains uncertain. This meta-analysis aimed to compare the effectiveness and safety of EVT versus best medical therapy (BMT) in this population. METHODS: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to September 2025 for comparative studies. The primary outcome was 90-day excellent functional outcome (modified Rankin Scale [mRS] score 0-1). Secondary outcomes included functional independence (mRS 0-2), symptomatic intracranial hemorrhage (sICH), and all-cause mortality. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. RESULTS: Seven observational studies involving 3,107 patients were included. In unadjusted analyses, EVT was associated with a higher rate of excellent functional outcome (OR 2.17; 95% CI 1.58-2.96) but not with functional independence (OR 1.58; 95% CI 0.90-2.77). After adjustment for confounders, EVT was associated with higher rate of excellent functional outcome (OR 2.86; 95% CI 1.89-4.31) and functional independence (OR 1.91; 95% CI 1.01-3.62). Safety outcomes including sICH and mortality did not differ significantly between groups. CONCLUSION: In patients with acute VBAO and mild symptoms, EVT may be associated with superior functional outcomes compared to BMT alone, without a significant increase in procedural risks. These findings suggest a potential role for EVT in selected patients with low NIHSS scores and underscore the need for confirmation in randomized trials.

References

1. 1.Qin, Y., Min, Z., Sun, G., Xu, H., Lu, J., & Liu, J. (2026). Endovascular thrombectomy versus best medical therapy for acute vertebrobasilar artery occlusion in patients with low NIHSS scores: a meta-analysis. Annals of Medicine. https://doi.org/10.1080/07853890.2026.2673631