Comparing Efficacy and Safety of Bridging Therapy versus Endovascular Thrombectomy in Acute Basilar Artery Occlusion: A Systematic Review and Meta-analysis

Background Basilar artery occlusion (BAO), a rare and severe stroke, causes high morbidity and mortality. This meta-analysis aims to compare bridging therapy, including endovascular thrombectomy (EVT) with intravenous thrombolysis (IVT), versus EVT alone in BAO. Methods PubMed, Cochrane Central, and ScienceDirect were searched till May 2025. The risk ratios (RR) along with 95% confidence intervals (CI) were pooled under the random effects model using the Review Manager software version 5.4.1. The quality assessment was done using the Cochrane risk of bias tool and the Newcastle Ottawa Scale. Publication bias was assessed visually through funnel plots and statistically via Egger’s regression test. Results Fourteen studies, encompassing 3,745 participants, were included in the analysis. Bridging therapy showed a statistically significant increase in functional independence (modified Rankin Scale (mRS) ≤ 2) (RR = 1.27; 95%CI: [1.13, 1.43]; p < 0.0001; I ²  = 23%) and independent ambulation (mRS ≤ 3) (RR = 1.10; 95%CI: [1.01, 1.20]; p = 0.02; I ²  = 0%). Mortality was also reduced significantly in bridging therapy (RR = 0.83; 95%CI: [0.75, 0.93]; p = 0.001; I ²  = 0%). The successful recanalization endpoint was found to be comparable between the bridging therapy and EVT alone arms (RR = 1.00; 95%CI: [0.97, 1.03]; p = 0.99; I ²  = 0%). Similarly, the spontaneous intracerebral hemorrhage also showed no significant difference between the two groups (RR = 0.99; 95%CI: [0.71, 1.39]; p = 0.97; I ²  = 0%). Conclusion Our meta-analysis supports administering IVT before EVT for BAO, showing benefits in functional outcomes and mortality without increasing hemorrhage risk, even though successful recanalization was similar in both groups.