Outcome of cervicocranial artery dissection with different treatments: a systematic review and meta-analysis.
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.
Department of Neurology, Drum Tower Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Yan
Y
Chen
Department of Neurology, Drum Tower Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Jing-Jing
JJ
Guan
Department of Neurology, Drum Tower Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Ai-Hua
AH
Liu
Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Hong
H
Ding
Department of Neurology, Drum Tower Hospital of Nanjing Medical University, Nanjing, People's Republic of China; Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China; Stroke Center for Diagnosis and Therapy in Jiangsu province, Jiangsu, People's Republic of China.
Yuan
Y
Shao
Department of Neurology, Drum Tower Hospital of Nanjing Medical University, Nanjing, People's Republic of China; Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China; Stroke Center for Diagnosis and Therapy in Jiangsu province, Jiangsu, People's Republic of China. Electronic address: xuyun20042001@aliyun.com.
Yun
Y
Xu
D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
Cervicocranial artery dissection; conservative treatment; endovascular treatment; meta-analysis