Outcome of cervicocranial artery dissection with different treatments: a systematic review and meta-analysis

J Stroke Cerebrovasc Dis. 2014 Mar;23(3):e177-86. doi: 10.1016/j.jstrokecerebrovasdis.2013.09.026. Epub 2013 Nov 11.

Abstract

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 = .02, odds ratio [OR]: .5, 95% confidence interval [CI]: .27-.90), especially patients having ruptured cervicocranial artery dissection (P = .002, OR: .32, 95% CI .15-.66) and dissecting aneurysms (P = .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 = .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 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.

Keywords: Cervicocranial artery dissection; conservative treatment; endovascular treatment; meta-analysis.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Aneurysm, Ruptured / diagnosis
  • Aneurysm, Ruptured / mortality
  • Aneurysm, Ruptured / therapy*
  • Aortic Dissection / diagnosis
  • Aortic Dissection / mortality
  • Aortic Dissection / therapy*
  • Chi-Square Distribution
  • Disability Evaluation
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / mortality
  • Humans
  • Intracranial Aneurysm / diagnosis
  • Intracranial Aneurysm / mortality
  • Intracranial Aneurysm / therapy*
  • Odds Ratio
  • Patient Selection
  • Risk Assessment
  • Risk Factors
  • Subarachnoid Hemorrhage / diagnosis
  • Subarachnoid Hemorrhage / mortality
  • Subarachnoid Hemorrhage / therapy*
  • Treatment Outcome