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Endovascular treatment versus standard medical treatment for acute basilar artery occlusion: protocol for a systematic review and meta-analysis
  1. Xuesong Bai1,2,
  2. Xiao Zhang1,2,
  3. Long Li1,2,
  4. Tao Wang1,2,
  5. Adam Andrew Dmytriw3,4,
  6. Yao Feng1,2,
  7. Kun Yang5,
  8. Xue Wang6,
  9. Yan Ma1,2,
  10. Liqun Jiao1,2,7
  1. 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
  2. 2China International Neuroscience Institute (China-INI), Beijing, China
  3. 3Department of Medical Imaging, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  4. 4Neuroradiology & Neurointervention Service, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  5. 5Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
  6. 6Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China
  7. 7Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Liqun Jiao; liqunjiao{at}


Introduction Acute basilar artery occlusion (BAO) can cause posterior circulation stroke. There are two predominant therapies for BAO: standard medical treatment (SMT) and SMT plus endovascular thrombectomy (EVT). However, a conclusive systematic comparison of the safety and efficacy of SMT and those of SMT plus EVT for the treatment of BAO is lacking. Thus, a systematic review and meta-analysis is needed to evaluate the safety and efficacy of SMT and SMT plus EVT for the treatment of BAO.

Methods and analysis This protocol is drafted referring to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines. We will search eligible studies from four main databases including MEDLINE, Web of Science, Cochrane Library and Embase. Randomised controlled trials (RCTs) and observational studies published before 1 October 2020 will be included. Two reviewers in our team will conduct the study selection and data extraction independently. Risk of bias will be assessed by Cochrane Collaboration criteria and the Newcastle-Ottawa scale for RCTs and observational studies, respectively. We will assess the good functional outcomes defining the modified Rankin scale score ≤2 at 90 days after treatment, short-term stroke severity as National Institutes of Health Stroke Scale score at 24 hours after intervention, and successful recanalisation as a modified Thrombolysis in Cerebral Infarction scale score of ≥2b after intervention. Also, safety outcomes will be assessed. The performance of this meta-analysis will depend on the quantity of included studies. The assessment of study heterogeneity will be performed by the I2 statistic. If there is mild heterogeneity (I2<20%) of intervention outcomes in included studies, the fixed-effect model will be applied; otherwise, the random-effect model will be performed. Subgroup analyses and an assessment of publication bias will also be conducted with sufficient data.

Ethics and dissemination No collection of primary data from patients is needed. Therefore, the ethical approval is unnecessary. The results may be presented in a peer-reviewed journal and related conferences.

PROSPERO registration number CRD42020176764.

  • stroke medicine
  • neuroradiology
  • stroke
  • neurosurgery

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  • Contributors XB, TW, LJ and YM contributed to the initial idea for this study. XW, XZ and YF developed and revised the search strategy. XB, LL, TW and XZ completed the study design. LJ and YM contributed to consults about clinical issues. XB, XZ, LL and AAD contributed to the original draft. LJ, YM and KY contributed to the revision of the draft. XB, XZ and LL contributed equally to this article. All of the authors approved the final work prior to submission.

  • Funding This work was supported by the Ministry of Science and Technology of the People’s Republic of China (2016YFC1301700) and the Beijing Scientific and Technologic Project (Z201100005520019).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Not required.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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