OutcomeofCervicocranialArteryDissectionwithDifferentTreatments

—ASystematicReviewandMeta-analysisIntroductionCervicocranialArteryDissection(CCAD):atearingoftheintimal,medialoradventitiallayersofthewallofthecerebralarteryleadingtoamuralhematomawithinthelayersofanarterialwallIntroduction-ManifestationVariesStrokethemostcommonseriouscomplicationTIANeckorheadpainPulsatiletinnitus“Lateralmedullary”symptomsHornersyndrome……CCADwasrecognizedasamajorcauseofstrokeintheyoungerpeopleIntroduction-TreatmentvariesConservativetreatment

anti-coagulants;antiplatelet;antihypertensivedrugsEndovasculartreatment

reconstructingordeconstructingtargetvesselswithballoons,coilsandstents

Sofar,norandomizedclinicaltrialsorstudieswithlargesamplestoguidetreatmentforCCAD.Method-StudySelectionandDataExtractionDatabase:Cochrane,MEDLINEandEMBASE.Time:fromNovember1964toMarch2013.Terms:(cervicocranialarterydissectionorcerebralarterydissectionorinternalcarotidarterydissectionorvertebrobasilararterydissectionorvertebralarterydissectionorbasilararterydissectionoranteriorcerebralarterydissectionormiddlecerebralarterydissectionorposteriorarterydissection)andtreatmentInaddition:

Referencesfromreviewsandselectedarticleswerealsoreviewedforpotentialrelevantcitations.InclusionandExclusionCriteriaIncludedwerestudiesthat:Comparedendovasculartreatmentandconservativetreatment.Included10ormorepatientswithCCADthatreceivedeitherconservativetreatmentorendovasculartreatment.Reportedatleastoneprimaryoutcomecomparingendovasculartreatmentandconservativetreatment,ignoringdifferenceinfollow-upperiod.InclusionandExclusionCriteriaExcludedwerestudiesthat:IncludednoCCADpatients.DidnotconsistofbothconservativetreatmentandendovasculartreatmentforCCAD.Didnotprovidesufficientoutcomedataforthetwotherapeuticstrategies.Includedlessthantwoendovascularorconservativegroupparticipants.Includedonlyreview,casereports,caseseries,commentary,guideline,editorial,authormanuscript,letters,andtechnicalnote.Includedonlynon-Englisharticlesorarticleswithoutfulltextavailable.ResultsofthesystematicliteraturesearchEndPointsDefinitionsDeath,fromanycause;Disability,ifthepatienthadaGOSof2to4,mRSof2to5,orKarnovskyscoreof10to70;Goodrecovery,

ifthepatienthadaGOSof5,mRSof0to1,orKarnovskyscoreof80to100.Result-DeathEggertest:P=0.681Beggtest:P=0.466Result-DisabilityResult-GoodrecoveryMeta-regressionanalysesyearofpublicationageofpatientsgenderstudydesignRegionsamplesizefollow-upperiodlocationofCCADSensitivityanalysesStudyomittedEstimate[95%Conf.Interval]Kurataetal,2001[19]0.6205760.3307711.164293Kimetal,2008[20]0.5025380.273430.923617Ramgrenetal,2005[24]0.5033560.2672340.948111Kimetal,2006[14]0.3775940.1971010.72337Hanetal,1998[18]0.4722830.2575660.865997Dengetal,2011[17]0.496270.2744860.897255Albuquerqueetal,2011[15]0.5033640.275730.918926Naitoetal,2002[21]0.496270.2744860.897255Jinetal,2013[11]0.5993930.3201721.122124Guietal,2010[22]0.5106280.2794910.932913Lasjauniasetal,2005[23]0.4518260.2441180.836263Anxionnatetal,2003[25]0.540990.292790.999594Zhaoetal,2007[16]0.5357240.2893260.991959Chungetal,2002[12]0.3877180.2054760.731593Kaietal,2011[13]0.496270.2744860.897255Combined0.496270.2744860.897255

SubgroupanalysesRuptured/unruptureddissectionAneurysm/non-aneurysmdissectionIntracranial/extracranialdissectionAnteriorcirculation/posteriorcirculationdissection

Rupturedgroup-DeathEggertest:P=0.358Beggtest:P=0.368Rupturedgroup–GoodrecoveryEggertest:P=0.549Beggtest:P=0.707Rupturedgroup–DisabilityRupturedgroup–RebleedingUnrupturedgroupPvalueOR(95%CI)Mortality0.430.25(0.01-7.34)Disability0.103.02(0.80-11.34)Goodrecovery0.180.41(0.11-1.51)Aneurysmgroup-DeathEggertest:P=0.637Beggtest:P=0.806Aneurysmgroup-DisabilityAneurysmgroup–GoodRecoveryNon-aneurysmgroupPvalueOR(95%CI)Mortality0.550.48(0.04-5.38)Disability0.154.32(0.60-31.15)Goodrecovery0.550.64(0.15-2.76)IntracranialDissectionPvalueOR(95%CI)Mortality0.090.37(0.12-1.17)Disability0.550.75(0.29-1.94)Goodrecovery0.092.13(0.89-5.08)PosteriorcirculationdissectionPvalueOR(95%CI)Mortality0.020.43(0.21-0.85)Disability0.091.83(0.91-3.68)Goodrecovery0.651.14(0.65-1.99)ConclusionsThecurrentmeta-analysismainlyfindsthatthemortalityinCCADpatientswithruptureddissection,pseudoaneurysm,anddissectionlocatinginposteriorcirculation,wassignificantlyreducedafterendovasculartreatment