Comparing efficacy and safety of direct aspiration versus stent retriever thrombectomy in acute basilar artery occlusion: A systematic review and meta-analysis

Abstract

Acute basilar artery occlusion (BAO) can lead to severe stroke and is linked to significant disability or death if not treated. This meta-analysis evaluated the effectiveness and safety of first-line thrombectomy options: Direct Aspiration (DA) and Stent Retriever Thrombectomy (SRT) for acute BAO. Electronic databases, including PubMed, Cochrane Central, ScienceDirect, Embase, and Web of Science were searched from inception until July 2025. Studies were included if they were RCTs or observational cohorts involving adults with acute BAO, comparing DA and SRT. The risk ratios (RR) and mean differences (MD) were pooled using Review Manager version. The Newcastle–Ottawa Scale (NOS) was used to assess quality. This meta-analysis included fifteen observational studies pooling 2214 patients. DA significantly increased the postoperative successful (RR = 1.04; 95% CI: 1.01 to 1.07; p = 0.008) and complete (RR = 1.19; 95% CI: 1.03 to 1.38; p = 0.02) recanalization compared to SRT. Similarly, symptomatic intracerebral hemorrhage (sICH) incidence was significantly reduced in the DA arm (RR = 0.65; 95% CI: 0.44 to 0.97; p = 0.04). DA is also associated with decreased procedural duration (MD = −35.17 min; 95% CI: −47.97 to −22.37; p < 0.00001). Meanwhile other outcomes, including postoperative mortality, rescue therapy, and favorable functional outcome were comparable between the 2 groups. DA demonstrated superior recanalization rates, reduced procedural duration, and a lower incidence of sICH compared to SRT. However, both techniques were comparable regarding other outcomes. Nevertheless, the observational study design limits the strength of the conclusion drawn.