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Title: Endovascular thrombectomy for tandem acute ischemic stroke associated with cervical artery dissection: a systematic review and meta-analysis.
Austin Authors: Dmytriw, Adam A;Phan, Kevin;Maingard, Julian T;Mobbs, Ralph J;Brooks, Duncan Mark ;Chen, Karen;Yang, Victor;Kok, Hong Kuan;Hirsch, Joshua A;Barras, Christen D;Chandra, Ronil V;Asadi, Hamed 
Affiliation: Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 263 McCaul St, Toronto, ON, M5T 1W7, Canada
Neurointerventional Radiology, Massachusetts General Hospital, Boston, MA, USA
The South Australian Health and Medical Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
Department of Radiology, Interventional Radiology Service, Northern Health, Melbourne, Australia
Neurointerventional Radiology, Brigham and Women's Hospital, Boston, MA, USA
Interventional Neuroradiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
Southwest Sydney Clinical School, University of New South Wales, Sydney, Australia
Liverpool Hospital, Liverpool, Australia
Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia
Department of Imaging, Monash University, Clayton, Victoria, Australia
Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 263 McCaul St, Toronto, ON, M5T 1W7, Canada
Issue Date: 12-Mar-2020
Date: 2020-03-12
Publication information: Neuroradiology 2020; online first: 12 March
Abstract: 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. 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. 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). 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.
DOI: 10.1007/s00234-020-02388-x
ORCID: 0000-0003-2475-9727
Journal: Neuroradiology
PubMed URL: 32166447
Type: Journal Article
Subjects: Image-guided procedures
Vascular disease
Appears in Collections:Journal articles

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