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01-07-2020 | Stroke | Interventional Neuroradiology

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

Authors: Adam A. Dmytriw, Kevin Phan, Julian Maingard, Ralph J. Mobbs, Mark Brooks, Karen Chen, Victor Yang, Hong Kuan Kok, Joshua A. Hirsch, Christen D. Barras, Ronil V. Chandra, Hamed Asadi

Published in: Neuroradiology | Issue 7/2020

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.

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Title: Endovascular thrombectomy for tandem acute ischemic stroke associated with cervical artery dissection: a systematic review and meta-analysis
Authors: Adam A. Dmytriw
Kevin Phan
Julian Maingard
Ralph J. Mobbs
Mark Brooks
Karen Chen
Victor Yang
Hong Kuan Kok
Joshua A. Hirsch
Christen D. Barras
Ronil V. Chandra
Hamed Asadi
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Thrombectomy
Published in: Neuroradiology / Issue 7/2020
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-020-02388-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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