To compare the efficacy and safety of endovascular thrombectomy (EVT) combined with intravenous thrombolysis (IVT) as bridging therapy versus EVT alone in patients with acute basilar artery occlusion (BAO).

BAO represents a serious medical condition associated with significant morbidity and mortality risks. EVT has emerged as the primary approach; however, the application of IVT alongside these techniques continues to be a subject of debate. Prior research on combining these two interventions as a bridging therapy has yielded conflicting results.

PubMed, Cochrane Central, and Embase were searched up to September 2024. Risk ratios (RR) and Mean Difference (MD) along with 95% Confidence Intervals (CI) were pooled for dichotomous and continuous outcomes respectively, using the Review Manager 5.4.1. The primary outcome was functional independence (Rankin modified scale [mRS] ≤2). The quality of the included studies was assessed through NOS and RoB 2.0 tools.

This meta-analysis included 3,685 patients from 3 RCTs and 11 Cohort studies. Patients undergoing EVT plus IVT (bridging therapy) exhibited a significantly increased Functional Independence (mRS ≤2) (RR = 1.27; 95% CI: [1.13–1.43]; p < 0.0001; I²= 23%) and Independent Ambulation (mRS ≤3) (RR = 1.10; 95% CI: [1.01–1.20]; p = 0.02; I²= 0%) along with decreased mortality (RR = 0.83; 95% CI:[0.75–0.93]; p = 0.001; I²= 0%) compared to those receiving EVT alone. No significant difference was observed in the risk of symptomatic intracerebral hemorrhage (sICH) (RR = 0.99; 95% CI: [0.71–1.39]; p = 0.97; I²= 0%) and Successful Recanalization rates (RR = 1.00; 95% CI: [0.97–1.03]; p = 0.99; I²= 0%).

The combination of EVT and IVT significantly improves functional outcomes and mortality without increasing sICH risk or recanalization rates in patients with acute BAO. Validating these findings and studying long-term impact requires further research.