Endovascular versus Non-Interventional Therapy for Cervicocranial Artery Dissection in East Asian and Non-East Asian Patients: a Systematic Review and Meta-analysis

Sci Rep. 2015 May 20:5:10474. doi: 10.1038/srep10474.

Abstract

Endovascular methods have been increasingly applied in treating cervicocranial artery dissection (CCAD). Anti-thrombotic therapy, which is used in non-interventional care of CCAD patients, has differential effects in East Asian patients. Therefore, we aimed to compare the clinical outcomes of endovascular versus non-interventional therapy for CCAD in East Asians and non-East Asians. A search was performed for studies comparing endovascular and non-interventional approaches to CCAD patients. Rates of recovery, disability, and mortality were used to assess these approaches in East Asian and non-East Asian patients. Subgroup analyses were conducted for CCAD patients with ruptured dissections. Eleven East Asian studies and five non-East Asian studies were included. The subgroup analyses for CCAD patients with ruptured dissections on mortality (East Asian odds ratio [OR] [95% confidence interval [CI]]: 0.24 [0.08-0.71], P = 0.01; I(2) = 34%) and good recovery (East Asian OR [95% CI]: 3.79 [1.14-12.60], P = 0.03; I(2) = 54%) revealed that endovascular therapy is significantly superior to non-interventional therapy for East Asians. No differences in treatment effect upon mortality, disability, or good recovery outcomes were found for the CCAD populations-at-large nor for non-East Asian CCAD patients with ruptured dissections. Endovascular therapy appears to be superior to non-interventional therapy for East Asian CCAD patients with ruptured dissections.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Angioplasty / methods*
  • Asia, Eastern
  • Carotid Artery, Internal, Dissection* / drug therapy
  • Carotid Artery, Internal, Dissection* / mortality
  • Carotid Artery, Internal, Dissection* / surgery
  • Endovascular Procedures / methods*
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Hematoma / drug therapy
  • Hematoma / mortality
  • Hematoma / surgery
  • Humans
  • Male
  • Middle Aged
  • Stents
  • Treatment Outcome
  • Tunica Intima / injuries
  • Tunica Intima / surgery
  • Vertebral Artery / injuries
  • Vertebral Artery / surgery

Substances

  • Fibrinolytic Agents