Adam A Dmytriw1, Kevin Phan2,3, Julian Maingard4,5, Ralph J Mobbs2,3, Mark Brooks5,6, Karen Chen7, Victor Yang8, Hong Kuan Kok9, Joshua A Hirsch10, Christen D Barras11, Ronil V Chandra12,13, Hamed Asadi4,6. 1. Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 263 McCaul St, Toronto, ON, M5T 1W7, Canada. adam.dmytriw@sunnybrook.ca. 2. Southwest Sydney Clinical School, University of New South Wales, Sydney, Australia. 3. Liverpool Hospital, Liverpool, Australia. 4. Department of Radiology, Austin Hospital, Melbourne, Australia. 5. Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia. 6. Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia. 7. Neurointerventional Radiology, Brigham and Women's Hospital, Boston, MA, USA. 8. Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 263 McCaul St, Toronto, ON, M5T 1W7, Canada. 9. Department of Radiology, Interventional Radiology Service, Northern Health, Melbourne, Australia. 10. Neurointerventional Radiology, Massachusetts General Hospital, Boston, MA, USA. 11. The South Australian Health and Medical Research Institute, The University of Adelaide, Adelaide, South Australia, Australia. 12. Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia. 13. Department of Imaging, Monash University, Clayton, Victoria, Australia.
Abstract
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.
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.