Clinical outcomes of patients with vertebral artery dissection treated endovascularly: a meta-analysis.
The purpose of this study was to present a meta-analysis on the safety and efficacy of different endovascular modalities when treating vertebral artery dissections, since ideal treatment remains controversial. We performed a meta-analysis of 39 retrospective studies involving different treatment modalities for vertebral artery dissections in adults and obtained weighted pooled proportional outcome and mortality ratios with a random effects model. Overall, 75.11 % (confidence interval (CI) 68.89-80.84, I (2) 66.89 %) had excellent outcomes, 10.10 % (CI 6.83-15.56, I (2) 65.64 %) had good outcomes, and 13.70 % (CI 9.64-18.35, I (2) 60.33 %) had poor outcomes. Postoperative complications occurred in 10.52 % (CI 6.87-14.84, I (2) 62.48 %), with 2.73 % (CI 1.64-4.10, I (2) 0.0 %) exhibiting vasospasm, 3.03 % (CI 1.88-4.46, I (2) 0.0 %) experiencing postoperative rebleeding, and 6.31 % (CI 3.57-9.76, I (2) 60.92 %) showing ischemia. Overall mortality was 8.69 % (CI 6.13-11.64, I (2) 33.76 %). When compared to these overall ratios, different treatment modality subgroups did not differ significantly, except for the proximal occlusion group, with poor outcome ratio = 26.96 % (difference 13.26, CI 0.02-30.04, p = 0.0403) and mortality ratio = 21.36 % (difference 12.67, CI 0.94-28.86, p = 0.0189). Different endovascular treatment modalities are comparatively safe and effective in the management of vertebral artery dissection. Their reduced operative time, minimal invasiveness, and overall safety render them a suitable option for intervention-amenable dissections.
Neurosurgical Service, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 745, Boston, MA, USA, drahernandezduran@gmail.com.
Silvia
S
Hernández-Durán
Christopher S
CS
Ogilvy
D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000601:surgery*