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

  • Interventional Neuroradiology
  • Published:
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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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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 263 McCaul St, Toronto, ON, M5T 1W7, Canada

    Adam A. Dmytriw & Victor Yang

  2. Southwest Sydney Clinical School, University of New South Wales, Sydney, Australia

    Kevin Phan & Ralph J. Mobbs

  3. Liverpool Hospital, Liverpool, Australia

    Kevin Phan & Ralph J. Mobbs

  4. Department of Radiology, Austin Hospital, Melbourne, Australia

    Julian Maingard & Hamed Asadi

  5. Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia

    Julian Maingard & Mark Brooks

  6. Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia

    Mark Brooks & Hamed Asadi

  7. Neurointerventional Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Karen Chen

  8. Department of Radiology, Interventional Radiology Service, Northern Health, Melbourne, Australia

    Hong Kuan Kok

  9. Neurointerventional Radiology, Massachusetts General Hospital, Boston, MA, USA

    Joshua A. Hirsch

  10. The South Australian Health and Medical Research Institute, The University of Adelaide, Adelaide, South Australia, Australia

    Christen D. Barras

  11. Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia

    Ronil V. Chandra

  12. Department of Imaging, Monash University, Clayton, Victoria, Australia

    Ronil V. Chandra

Authors
  1. Adam A. Dmytriw
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  2. Kevin Phan
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  7. Victor Yang
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  9. Joshua A. Hirsch
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Corresponding author

Correspondence to Adam A. Dmytriw.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Dmytriw, A.A., Phan, K., Maingard, J. et al. Endovascular thrombectomy for tandem acute ischemic stroke associated with cervical artery dissection: a systematic review and meta-analysis. Neuroradiology 62, 861–866 (2020). https://doi.org/10.1007/s00234-020-02388-x

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  • DOI: https://doi.org/10.1007/s00234-020-02388-x

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