Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 263 McCaul St, Toronto, ON, M5T 1W7, Canada.
Southwest Sydney Clinical School, University of New South Wales, Sydney, Australia.
Neuroradiology. 2020 Jul;62(7):861-866. doi: 10.1007/s00234-020-02388-x. Epub 2020 Mar 12.
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.
与颈内动脉夹层相关的中风主要采用抗血栓药物治疗，但效果不佳。血管内血栓切除术的附加作用尚不清楚。本研究旨在进行系统评价和荟萃分析，比较血管内血栓切除术和药物治疗与颈内动脉夹层相关的急性缺血性中风。
从六个电子数据库中纳入接受血管内血栓切除术治疗的急性缺血性中风继发于颈内动脉夹层的患者队列研究结果。采用随机效应模型进行比例荟萃分析。90 天改良 Rankin 评分（mRS 0-2）为主要结局。其他结局包括血栓溶解（TICI）2b-3 级血流、90 天死亡率和 90 天症状性颅内出血（sICH）率的患者比例。
纳入 6 项研究，共 193 例接受血栓切除术治疗，59 例接受药物治疗。血栓切除术组的血管再通率为 74%，合并 TICI 2b-3 级血流。联合血栓切除术组的良好结局（mRS 0-2）优于药物治疗组（62.9%，95%CI 55.8-69.5% vs. 41.5%，95%CI 29.0-55.1%，P=0.006）。血管内 vs 药物治疗的 90 天死亡率相似（8.6% vs. 6.3%）。症状性颅内出血（sICH）的发生率无显著差异（5.9% vs. 4.2%，P=0.60）。
目前的数据表明，血管内血栓切除术可能是颈内动脉夹层引起的急性缺血性中风患者的一种选择。这需要在更高质量的前瞻性研究中进一步证实。
