Endovascular thrombectomy for tandem acute ischemic stroke associated with cervical artery dissection: a systematic review and meta-analysis.,Neuroradiology

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Endovascular thrombectomy for tandem acute ischemic stroke associated with cervical artery dissection: a systematic review and meta-analysis.
Neuroradiology ( IF 2.4 ) Pub Date : 2020-03-12 , DOI: 10.1007/s00234-020-02388-x
Adam A Dmytriw ₁ , Kevin Phan _{2,

3} , Julian Maingard _{4,

5} , Ralph J Mobbs _{2,

3} , Mark Brooks _{5,

6} , Karen Chen ₇ , Victor Yang ₁ , Hong Kuan Kok ₈ , Joshua A Hirsch ₉ , Christen D Barras ₁₀ , Ronil V Chandra _{11,

12} , Hamed Asadi _{4,

6}

Affiliation

Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 263 McCaul St, Toronto, ON, M5T 1W7, Canada.
Southwest Sydney Clinical School, University of New South Wales, Sydney, Australia.
Liverpool Hospital, Liverpool, Australia.
Department of Radiology, Austin Hospital, Melbourne, Australia.
Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia.
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia.
Neurointerventional Radiology, Brigham and Women's Hospital, Boston, MA, USA.
Department of Radiology, Interventional Radiology Service, Northern Health, Melbourne, Australia.
Neurointerventional Radiology, Massachusetts General Hospital, Boston, MA, USA.
The South Australian Health and Medical Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia.
Department of Imaging, Monash University, Clayton, Victoria, Australia.

Purpose

Strokes associated with cervical artery dissection have been managed primarily with antithrombotics with poor outcomes. The additive role of endovascular thrombectomy remains unclear. The objective was to perform systematic review and meta-analysis to compare endovascular thrombectomy and medical therapy for acute ischemic stroke associated with cervical artery dissection.

Methods

Studies from six electronic databases included outcomes of patient cohorts with acute ischemic stroke secondary to cervical artery dissection who underwent treatment with endovascular thrombectomy. A meta-analysis of proportions was conducted with a random effects model. Modified Rankin score at 90 days (mRS 0–2) was the primary outcome. Other outcomes included proportion of patients with thrombolysis in cerebral infarction (TICI) 2b-3 flow, 90-day mortality rate, and 90-day symptomatic intracerebral hemorrhage (sICH) rate.

Results

Six studies were included, comprising 193 cases that underwent thrombectomy compared with 59 cases that were managed medically. Successful recanalization with a pooled proportion of thrombolysis in cerebral infarction (TICI) 2b-3 flow in the thrombectomy group was 74%. Favorable outcome (mRS 0–2) was superior in the pooled thrombectomy group (62.9%, 95% CI 55.8–69.5%) compared with medical management (41.5%, 95% CI 29.0–55.1%, P = 0.006). The pooled rate of 90-day mortality was similar for endovascular vs medical (8.6% vs 6.3%). The pooled rate of symptomatic intracranial haemorrhage (sICH) did not significantly differ (5.9% vs 4.2%, P = 0.60).

Conclusions

Current data suggest that endovascular thrombectomy may be an option in patients with acute ischemic stroke due to cervical artery dissection. This requires further confirmation in higher quality prospective studies.

中文翻译：

血管内血栓切除术治疗与颈动脉夹层相关的串联急性缺血性中风：系统评价和荟萃分析。

目的

与颈动脉夹层相关的中风主要通过抗栓药治疗，但效果较差。血管内血栓切除术的附加作用仍不清楚。目的是进行系统的回顾和荟萃分析，以比较血管内血栓切除术和药物治疗与颈动脉夹层相关的急性缺血性卒中。

方法

来自六个电子数据库的研究包括接受血管内血栓切除术治疗的继发于颈动脉夹层的急性缺血性卒中患者队列的结果。使用随机效应模型进行比例的荟萃分析。主要的结果是在90天时改良兰金评分（mRS 0–2）。其他结局包括脑梗塞（TICI）2b-3血流中溶栓患者的比例，90天死亡率和90天症状性脑出血（sICH）率。

结果

包括6项研究，包括193例接受了血栓切除术的患者，而59例接受了医学治疗。在血栓切除术组中，在脑梗死（TICI）2b-3血流中溶栓的比例增加，成功的再通成功率为74％。与药物治疗组（41.5％，95％CI 29.0-55.1％，P = 0.006）相比，合并血栓切除术组的良好结果（mRS 0–2）更好（62.9％，95％CI 55.8–69.5％）。血管内和医疗的90天死亡率合并率相似（8.6％对6.3％）。有症状的颅内出血（sICH）的合并率没有显着差异（5.9％vs 4.2％，P = 0.60）。