Objective:

To systematically evaluate the efficacy and safety of endovascular therapy for vertebrobasilar artery occlusion (VBAO) by integrating evidence from randomized controlled trials (RCTs) and real-world data, highlighting the importance of this integration for clinical practice.

Key Findings:

• EVT significantly improved favorable functional outcomes (mRS score 0–3) compared to SMT (OR = 1.92; 95% CI 1.51–2.43).
• EVT was associated with higher rates of functional independence (mRS score 0–2) (OR = 1.76; 95% CI 1.39–2.23).
• EVT reduced 90-day all-cause mortality (OR = 0.58; 95% CI 0.49–0.68).
• Increased risk of symptomatic intracranial hemorrhage with EVT (OR = 2.57; 95% CI 1.31–5.06).
• Subgroup analyses indicated EVT benefits in specific patient groups but not in elderly patients or those with mild deficits.

Interpretation:

Endovascular therapy is a cornerstone treatment for acute VBAO, showing significant improvements in functional outcomes and mortality despite an increased risk of symptomatic intracranial hemorrhage, which necessitates careful patient selection.

Limitations:

• Limited generalizability due to strict inclusion criteria in RCTs, which may not reflect broader patient populations.
• Potential biases in observational studies that could affect the reliability of findings.
• Variability in treatment protocols across studies, which may influence outcomes.

Conclusion:

This analysis supports the use of EVT for VBAO, highlighting its efficacy in improving patient outcomes while acknowledging associated risks, particularly the increased risk of hemorrhage.