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

Yaqin Qin·Zhuo Min·Guangxin Sun·Hui Xu·Jinghong Lu·Jun Liu
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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.

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HumansThrombectomyEndovascular ProceduresVertebrobasilar InsufficiencyTreatment OutcomeStrokeObservational Studies as TopicIntracranial HemorrhagesIschemic strokeNational Institutes of Health Stroke Scaleendovascular thrombectomyvertebrobasilar arteryJournal ArticleMeta-AnalysisComparative StudySystematic ReviewResearch Support, Non-U.S. Gov't

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Yaqin Qin, Zhuo Min, Guangxin Sun, Hui Xu, Jinghong Lu, Jun Liu. 2026-05-16. Endovascular thrombectomy versus best medical therapy for acute vertebrobasilar artery occlusion in patients with low NIHSS scores: a meta-analysis.. https://doi.org/10.1080/07853890.2026.2673631

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Comparative Study subjectEndovascular Procedures subjectEndovascular thrombectomy subjectHumans subjectIntracranial Hemorrhages subjectIschemic Stroke subjectJournal Article subjectMeta-Analysis subjectNational Institutes of Health Stroke Scale subjectObservational Studies as Topic subjectSystematic reviews study

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PubMed2026

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