AI Article Synopsis
- The meta-analysis aims to compare clinical outcomes of endovascular treatment versus conservative treatment for patients with cervicocranial artery dissection.
- The analysis included 15 studies and 442 patients, evaluating outcomes like mortality rate, disability, recovery, and rebleeding rates in subarachnoid hemorrhage cases.
- Results show that endovascular treatment significantly lowers mortality rates, especially in patients with ruptured dissection and higher Hunt-Hess scores, suggesting the need for more randomized controlled trials to further evaluate these treatments.
Article 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.
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| http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.09.026 | DOI Listing |
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