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Title: | Endovascular thrombectomy for tandem acute ischemic stroke associated with cervical artery dissection: a systematic review and meta-analysis. | Authors: | Chen K.;Hirsch J.A.;Kok H.K.;Dmytriw A.A.;Phan K.;Maingard J.;Mobbs R.J.;Brooks M.;Yang V.;Asadi H.;Chandra R.V.;Barras C.D. | Monash Health Department(s): | Radiology | Institution: | (Dmytriw, Yang) Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 263 McCaul St, Toronto, ON M5T 1W7, Canada (Phan, Mobbs) Southwest Sydney Clinical School, University of New South Wales, Sydney, Australia (Phan, Mobbs) Liverpool Hospital, Liverpool, Australia (Maingard, Asadi) Department of Radiology, Austin Hospital, Melbourne, Australia (Maingard, Brooks) Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia (Brooks, Asadi) Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia (Chen) Neurointerventional Radiology, Brigham and Women's Hospital, Boston, MA, United States (Kok) Department of Radiology, Interventional Radiology Service, Northern Health, Melbourne, Australia (Hirsch) Neurointerventional Radiology, Massachusetts General Hospital, Boston, MA, United States (Barras) The South Australian Health and Medical Research Institute, The University of Adelaide, Adelaide, SA, Australia (Chandra) Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, VIC, Australia (Chandra) Department of Imaging, Monash University, Clayton, VIC, Australia | Issue Date: | 3-Jul-2020 | Copyright year: | 2020 | Publisher: | Springer | Place of publication: | Germany | Publication information: | Neuroradiology. 62 (7) (pp 861-866), 2020. Date of Publication: 01 Jul 2020. | Journal: | Neuroradiology | 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. Method(s): 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. Result(s): 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). Conclusion(s): 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.Copyright © 2020, Springer-Verlag GmbH Germany, part of Springer Nature. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1007/s00234-020-02388-x | PubMed URL: | 32166447 [http://www.ncbi.nlm.nih.gov/pubmed/?term=32166447] | ISSN: | 0028-3940 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/29215 | Type: | Review | Subjects: | brain infarction brain ischemia brain ischemia [Surgery] brain hemorrhage Newcastle-Ottawa scale percutaneous thrombectomy Rankin scale artery dissection [Surgery] cervical artery dissection [Surgery] antithrombocytic agent Medical Subject Headings |
Type of Clinical Study or Trial: | Systematic review and/or meta-analysis |
Appears in Collections: | Articles |
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