Safety and Efficacy of Thrombolysis in Cervical Artery Dissection-Related Ischemic Stroke: A Meta-Analysis of Observational Studies

Abstract

Background: Although thrombolysis is considered to be the first-line treatment for ischemic stroke, there remains an ongoing controversy on the safety and efficacy of thrombolysis in cervical artery dissection (CAD). The aim of this meta-analysis was to assess observational data related to the safety and efficacy of thrombolysis in CAD-related ischemic stroke. Methods: We performed a systematic search of the efficacy of thrombolysis treatment in CAD-related ischemic stroke with appropriate observational studies identified for the study. The meta-analysis models in Comprehensive Meta-Analysis V2 software were applied to calculate the merged rates of favorable outcome (modified Rankin Scale, mRS 0-2), excellent outcome (mRS 0-1), intracranial hemorrhage (ICH), symptomatic ICH (SICH), mortality and recurrent stroke between thrombolysis and non-thrombolysis in CAD-related stroke. The difference of outcomes and adverse events between the 2 groups was compared by analyzing the pooled OR value and chi-square test using the software SPSS. Results: A total of 846 patients were identified from 10 studies (174 with thrombolysis; 672 with non-thrombolysis). The meta-analysis detected no significant statistical difference in the proportion of CAD-related stroke patients enjoying a favorable outcome at the 3 months' follow-up between the thrombolysis and non-thrombolysis groups (53.7 vs. 58.2%, OR 0.782, χ² = 0.594, p > 0.05); non-thrombolysis was slightly superior than thrombolysis in terms of excellent outcome (52.4 vs. 34.4%, OR 0.489, χ² = 9.143, p = 0.002). There was no significant difference in SICH, mortality and recurrent stroke rates between the 2 groups (all p > 0.05). ICH rate was higher in the thrombolysis group of CAD-related stroke patients compared to that in the non-thrombolysis group (12.3 vs. 7.4%, OR 2.647, χ² = 4.127, p = 0.042). Conclusion: Thrombolysis seems to be equally safe and will achieve an efficacy similar to the efficacy of non-thrombolysis in patients with acute ischemic stroke due to CAD. It is also as effective as thrombolysis in stroke from miscellaneous causes. Therefore, CAD patients experiencing a stroke should not be denied thrombolysis therapy. However, this will need to be confirmed in large-scale randomized studies, especially involving intravenous thrombolysis treatment.

A Posterior Circulation Stroke Presenting with Isolated Truncal Ataxia

“…The use of thrombolytics is controversial, but may also be considered for patients presenting with stroke resulting from vertebral artery dissections. While not directly studied in VAD, a recent metanalysis of thrombolysis in ischemic stroke caused by cervical artery dissection (which includes both carotid and vertebral dissection-related stroke) found that thrombolysis in patients has comparable safety and functional outcomes to thrombolysis in patients with non-dissection-related strokes [ 2 ]. However, further randomized controlled trials (RCT) need to be performed to assess the safety and efficacy of thrombolytics in strokes caused solely by VAD, prior to routine use of thrombolysis in these patients.…”

“…Treatment options include anticoagulation or antiplatelet therapy. In patients with signs of acute ischemia, intravenous thrombolysis or endovascular intervention may also be indicated [ 2 - 3 ].…”

The superiority of high‐power short‐duration radiofrequency catheter ablation strategy for atrial fibrillation treatment: A systematic review and meta‐analysis study

“…We applied the combination of Begg’s and Egger’s tests to assess the presence of publication bias. The P ‐value of Begg’s test and/or Egger’s test <.05 indicated the presence of publication bias 23 . The pooled risk ratio (RR) and 95% CI for categorical data were calculated using the Mantel–Haenszel statistical method.…”

Cervical and intracranial artery dissections

“…In 2016, a systematic literature review across 10 observational studies reporting on 174 IVT-treated CeAD patients and 672 CeAD patients treated without IVT (control group) 21 showed that the likelihood of favorable outcome (i.e. mRS 0, 1, 2) and the odds for an excellent functional outcome (i.e.…”