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Endovascular and Antithrombotic Treatment in Blunt Cerebrovascular Injuries: A Systematic Review and Meta-Analysis.

Authors
  • Priola, Stefano M1
  • Ku, Jerry C2
  • Palmisciano, Paolo3
  • Taslimi, Shervin4
  • Mathieu, Francois2
  • Pasarikovski, Christopher R2
  • Malhotra, Armaan2
  • Umana, Giuseppe E3
  • Scalia, Gianluca5
  • Tomasi, Santino O6
  • Raudino, Giuseppe6
  • Yang, Victor X D7
  • da Costa, Leodante8
  • 1 Division of Neurosurgery, Department of Surgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada; Division of Trauma Surgery, Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, Humanitas Centro Catanese di Oncologia, Catania, Italy. Electronic address: [email protected] , (Canada)
  • 2 Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Trauma Surgery, Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, Humanitas Centro Catanese di Oncologia, Catania, Italy. , (Canada)
  • 3 Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy; Division of Trauma Surgery, Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, Humanitas Centro Catanese di Oncologia, Catania, Italy. , (Canada)
  • 4 Division of Neurosurgery, Department of Surgery, Queen's University, Kingston, ON, Canada; Division of Trauma Surgery, Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, Humanitas Centro Catanese di Oncologia, Catania, Italy. , (Canada)
  • 5 Department of Neurosurgery, Highly Specialized Hospital of National Importance "Garibaldi", Catania, Italy; Division of Trauma Surgery, Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, Humanitas Centro Catanese di Oncologia, Catania, Italy. , (Canada)
  • 6 Christian Doppler Klinik, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria; Division of Trauma Surgery, Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, Humanitas Centro Catanese di Oncologia, Catania, Italy. , (Austria)
  • 7 Division of Neurosurgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada; Division of Trauma Surgery, Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, Humanitas Centro Catanese di Oncologia, Catania, Italy. , (Canada)
  • 8 Division of Neurosurgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada; Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada; Division of Trauma Surgery, Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, Humanitas Centro Catanese di Oncologia, Catania, Italy. , (Canada)
Type
Published Article
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
Publication Date
Apr 04, 2022
Volume
31
Issue
6
Pages
106456–106456
Identifiers
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106456
PMID: 35390729
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Ischemic 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. PubMed, 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. We 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). AT 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. Copyright © 2022 Elsevier Inc. All rights reserved.

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