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This study compares bridging intravenous thrombolysis and endovascular thrombectomy versus direct endovascular thrombectomy in a larger-than-ever basilar artery occlusion Population. Embase, PubMed, Scopus, Web of Science, and Cochrane Library were systematically searched. Studies that reported 90-day functional independence (mRS: 0\u20132), 90-day independent ambulation (mRS: 0\u20133), successful recanalization, symptomatic intracranial hemorrhage, any type of intracranial hemorrhage, and 90-day mortality were included. Two reviewers independently extracted data and assessed bias using ROBINS-I. A random-effects model was used. The protocol was registered in PROSPERO (CRD42024519161). Fifty-eight studies with 9372 subjects were included in the final analysis. Bridging therapy was associated with higher 90-day functional independence (OR 1.46; 95% CI 1.22\u20131.76;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and lower 90-day mortality (OR 0.63; 95% CI 0.49\u20130.82;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002). No significant differences were found in recanalization rate (OR 0.97; 95% CI 0.79\u20131.18;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.707) or symptomatic intracranial hemorrhage (OR 0.88; 95% CI 0.65\u20131.18;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.330). Benefits were consistent across subgroups defined by stroke severity, treatment window, occlusion site, and study site. Bridging therapy for basilar artery occlusion patients leads to a higher rate of functional independence and lower mortality without increasing the rate of intracranial hemorrhage compared to direct endovascular thrombectomy consistently across all subgroups.\n                  <\/jats:p>","DOI":"10.1007\/s11357-025-01887-0","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T19:14:00Z","timestamp":1758222840000},"page":"4099-4120","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Bridging therapy versus direct endovascular thrombectomy in basilar artery\u00a0occlusion stroke: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"48","author":[{"given":"Esra","family":"Zhubi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azamat","family":"Bissenov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Anne","family":"Engh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00e9ka","family":"T\u00f3th","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e1s Attila","family":"Horv\u00e1th","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hegyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2481-321X","authenticated-orcid":false,"given":"Bence","family":"Gunda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"1887_CR1","doi-asserted-by":"publisher","first-page":"1302298","DOI":"10.3389\/fneur.2024.1302298","volume":"15","author":"YZ Imam","year":"2024","unstructured":"Imam YZ, et al. 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