Department of Vascular and Endovascular Surgery, The Galway Clinic, Galway, Ireland.
Department of Vascular and Endovascular Surgery, University College Hospital, Galway, Ireland.
Cochrane Database Syst Rev. 2021 Feb 1;2(2):CD013118. doi: 10.1002/14651858.CD013118.pub2.
Cervical artery dissection (CeAD) is a pathological bleed or tear, or both, in the wall of the carotid or vertebral arteries as they course through the neck, and is a leading cause of stroke in young people.
To assess the effectiveness of surgical and radiological interventions versus best medical treatment alone for treating symptomatic cervical artery dissection.
We performed comprehensive searches of the Cochrane Stroke Group Trials Register (last searched March 2020), the Cochrane Central Register of Controlled Trials (CENTRAL), 2020, Issue 4, in the Cochrane Library (searched March 2020), MEDLINE (1946 to March 2020) and Embase (1974 to March 2020). We searched relevant ongoing trials and research registers (searched March 2020), checked references in all relevant papers for additional eligible studies, and contacted authors and researchers in the field.
Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of either surgical or endovascular intervention for the management of symptomatic CeAD were eligible for inclusion. Only studies with anticoagulants or antiplatelet treatment as the control group were included. Two review authors planned to independently extract data.
Primary outcomes were ipsilateral stroke and disability. Secondary outcomes were death, any stroke, or transient ischaemic attack, residual stenosis (> 50%), recurrence of cervical dissection, expanding pseudoaneurysm, or major bleeding. We analysed the studies according to the first choice of treatment. We planned to assess for risk of bias and apply GRADE criteria for any included studies.
We did not find any completed RCTs or CCTs undertaken in this area of research.
AUTHORS' CONCLUSIONS: No RCTs or CCTs compared either surgery or endovascular therapy with control. Thus, there is no available evidence to support their use for the treatment of extracranial cervical artery dissection in addition to antithrombotic therapy in people who continue to have neurological symptoms when treated with antithrombotic therapy alone.
颈内动脉夹层（CeAD）是颈动脉或椎动脉在穿过颈部时发生的病理性出血或撕裂，或两者兼有，是年轻人中风的主要原因。
评估手术和放射介入治疗与单独最佳药物治疗对治疗症状性颈内动脉夹层的效果。
我们对 Cochrane 卒中组试验注册库（最近检索日期为 2020 年 3 月）、Cochrane 中央对照试验注册库（CENTRAL，2020 年第 4 期，Cochrane 图书馆）、MEDLINE（1946 年至 2020 年 3 月）和 Embase（1974 年至 2020 年 3 月）进行了全面检索。我们还检索了相关的正在进行的试验和研究登记处（最近检索日期为 2020 年 3 月），查阅了所有相关文献中的参考文献以获取其他合格的研究，并联系了该领域的作者和研究人员。
符合纳入条件的是手术或血管内介入治疗症状性 CeAD 的随机对照试验（RCT）和对照临床试验（CCT）。仅纳入了以抗凝或抗血小板治疗为对照组的研究。两位综述作者计划独立提取数据。
主要结局是同侧中风和残疾。次要结局是死亡、任何中风或短暂性脑缺血发作、残余狭窄（>50%）、颈内动脉夹层复发、扩张性假性动脉瘤或大出血。我们根据首选治疗方案对研究进行了分析。我们计划评估纳入研究的偏倚风险，并应用 GRADE 标准进行评估。
我们未发现该研究领域开展的任何已完成的 RCT 或 CCT。
没有 RCT 或 CCT 将手术或血管内治疗与对照组进行比较。因此，对于单独接受抗血栓治疗时仍有神经症状的患者，除了抗血栓治疗外，手术或血管内治疗在治疗颅外颈内动脉夹层方面的应用没有可提供的证据支持。
