Outcome of Cervicocranial Artery Dissection with Different Treatments: A Systematic Review and Meta-analysis

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• 作者：Yan Chen ; PhD^&lowast ; ; Jing-Jing Guan ; MSc^&lowast ; ; Ai-Hua Liu ; MSc^&lowast ; ; Hong Ding ; MD^§ ; ; Yuan Shao ; MD^&lowast ; ; ^&dagger ; ; ^&Dagger ; ; Yun Xu ; MD ; PhD^&lowast ; ; ^&dagger ; ; ^&Dagger ; ; ^{xuyun20042001@aliyun.com" class="auth_mail}
• 关键词：Cervicocranial artery dissection ; endovascular treatment ; conservative treatment ; meta-analysis
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：March, 2014
• 年：2014
• 卷：23
• 期：3
• 页码：e177-e186
• 全文大小：2045 K

文摘

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Objective

The purpose of this meta-analysis is to compare clinical outcomes between endovascular treatment and conservative treatment for cervicocranial artery dissection.

Methods

Medline, Embase, and Cochrane Library databases were searched for studies comparing endovascular treatment versus conservative treatment for cervicocranial artery dissection patients. The period searched was from November 1994 to March 2013. Fifteen observational studies involving 442 cervicocranial artery dissection patients were found. Evaluated outcomes included rate of mortality, disability, and good recovery. The rebleeding rate in subarachnoid hemorrhage (SAH) patients was also recorded and compared.

Results

In general, patients who received endovascular treatment enjoyed a lower mortality rate than those who received conservative treatment (P聽=聽.02, odds ratio [OR]: .5, 95% confidence interval [CI]: .27-.90), especially patients having ruptured cervicocranial artery dissection (P聽=聽.002, OR: .32, 95% CI .15-.66) and dissecting aneurysms (P聽=聽.006, OR: .31, 95% CI .14-.71). Among SAH patients with a Hunt-Hess score of 3 or more, endovascular treatment decreased mortality significantly (P聽=聽.006, OR: .22, 95% CI .08-.65), whereas no significant differences between these 2 treatments occurred in patients having a Hunt-Hess score less than聽3.

Conclusions

Endovascular treatment yields a better outcome, with greater benefit in patients with ruptured cervicocranial artery dissection, dissecting aneurysms, and a Hunt-Hess score of 3 or more. Randomized controlled trials comparing these 2 therapeutic strategies are needed.