Endovascular and Antithrombotic Treatment in Blunt Cerebrovascular Injuries: A Systematic Review and Meta-Analysis |
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| Affiliation: | 1. Division of Neurosurgery, Department of Surgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada;2. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada;3. Division of Neurosurgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada;4. Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada;5. Division of Trauma Surgery, Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada;6. Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy;7. Department of Neurosurgery, Highly Specialized Hospital of National Importance “Garibaldi”, Catania, Italy;8. Christian Doppler Klinik, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria;9. Department of Neurosurgery, Humanitas Centro Catanese di Oncologia, Catania, Italy;10. Division of Neurosurgery, Department of Surgery, Queen''s University, Kingston, ON, Canada;1. Department of Vascular Surgery, Escuela de Medicina, Pontificia Universidad Católica de Chile;2. Department of Neurology, Escuela de Medicina, Pontificia Universidad Católica de Chile;3. Center for Endovascular Therapy, Pontificia Universidad Católica de Chile;4. Department of Radiology, Escuela de Medicina, Pontificia Universidad Católica de Chile;1. Department of Neurology, Yongchuan Hospital of Chongqing Medical University, 439 Xuanhua Road, Yongchuan District, Chongqing 402160, China;2. Chongqing Key Laboratory of Cerebrovascular Disease Research, 439 Xuanhua Road, Yongchuan District, Chongqing, China;1. Department of Neurology, Institute of Post Graduate Medical Education & Research, Bangur Institute of Neurosciences, Kolkata, India;2. Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, India;1. University of Minnesota, MMC 295, 420 Delaware Street SE, Minneapolis, MN 55455, United States;2. HealthPartners Neuroscience Center, United States;3. HealthPartners Institute, United States;1. Department of Radiology, the Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian, Liaoning 116027, China;2. Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian, Liaoning 116027, China;1. Department of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA;2. Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA;3. Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA;4. Department of Neurosurgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA;5. University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA |
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| Abstract: | ObjectivesIschemic stroke has been estimated to occur in up to 26% of patients with blunt cerebrovascular injury (BCVI). Antithrombotic therapy (AT) may be used for stroke prevention, but the role of endovascular treatment (ET) remains unclear. We systematically reviewed the literature on AT and ET for the treatment of patients with BCVIs.Materials and methodsPubMed, EMBASE, Web of Science, and Cochrane were searched upon the PRISMA guidelines to include studies reporting the use of ET in BCVI patients. Post-ET neurologic outcomes, radiographic responses, and complication rates were assessed. A fixed-effect model meta-analysis was performed to compare treatment-related post-BCVI ischemic stroke rates between AT and ET protocols.ResultsWe included 16 studies comprising 352 patients undergoing ET for BCVI. Mean post-ET rates of good neurologic outcomes and radiologic responses were 86.9% (range, 63.6–100%) and 94.0% (range 57.1–100%), respectively. Mean post-ET complication rate was 5.2% (range, 0–66.7%). Seven studies compared the roles of AT (delivered in 805 patients) and ET (performed in 235 patients) for preventing the onset of post-BCVI ischemic strokes. No significant difference in rates of post-BCVI ischemic stroke was found between patients receiving AT vs patients undergoing ET (OR 0.71, 95% CI: 0.35–1.42, p = 0.402).ConclusionAT and ET may be comparable in preventing the occurrence of ischemic stroke following BCVIs. AT may be preferred as the less-invasive first-line therapy, but ET showed favorable rates of post-treatment clinical and radiologic outcomes, coupled with low rates of treatment-related complications. |
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