Background and ObjectivesIn young people aged < 50 years, cervical artery dissection (CeAD) is among the most common causes of stroke. Currently, there is no consensus regarding the safest and most effective antithrombotic treatment for CeAD. We aimed to synthesize concrete evidence from studies that compared the efficacy and safety of antiplatelet (AP) versus anticoagulant (AC) therapies for CeAD. Methods We searched major electronic databases/search engines from inception till September 2021. Cohort studies and randomized controlled trials (RCTs) comparing anticoagulants with antiplatelets for CeAD were included. A meta-analysis was conducted using articles that were obtained and found to be relevant. Mean difference (MD) with 95% confidence interval (CI) was used for continuous data and odds ratio (OR) with 95% CI for dichotomous data. Results Our analysis included 15 studies involving 2064 patients, 909 (44%) of whom received antiplatelets and 1155 (56%) received anticoagulants. Our analysis showed a non-significant difference in terms of the 3-month mortality (OR 0.47, 95% CI 0.03-7.58), > 3-month mortality (OR 1.63, 95% CI 0.40-6.56), recurrent stroke (OR 0.97, 95% CI 0.46-2.02), recurrent transient ischaemic attack (TIA) (OR 0.93, 95% CI 0.44-1.98), symptomatic intracranial haemorrhage (sICH) (OR 0.38, 95% CI 0.12-1.19), and complete recanalization (OR 0.70, 95% CI 0.46-1.06). Regarding primary ischaemic stroke, the results favoured AC over AP among RCTs (OR 6.97, 95% CI 1. 25-38.83). Conclusion Our study did not show a considerable difference between the two groups, as all outcomes showed non-significant differences between them, except for primary ischaemic stroke (RCTs) and complete recanalization (observational studies), which showed a significant favour of AC over AP. Even though primary ischaemic stroke is an important outcome, several crucial points that could affect these results should be paid attention to. These include the incomplete adjustment for the confounding effect of AP-AC doses, frequencies, administration compliance, and others. We recommend more well-designed studies to assess if unnecessary anticoagulation can be avoided in CeAD.

Introduction In certain circumstances, mobile stroke units (MSU) with on‐site treatment teams and a computed tomography scanner may offer faster therapy with tissue plasminogen activator (tPA) for stroke patients who need immediate treatment. We conducted a systematic review and meta‐analysis to compare clinical outcomes in MSU patients to those in conventional care. Methods We searched key electronic databases from inception till September 2021. The primary outcomes were mortality at 7 days and 90 days. The secondary outcomes included modified Rankin scale (mRS) at 90 days, alarm to intravenous thrombolysis (IVT) or intra‐arterial recanalization, and time from symptom onset or last known well (LKW) to thrombolysis. Results We included nineteen controlled trials and cohort studies to conduct our final analysis. Our comparison revealed that 90‐day mortality rate significantly declined in MSU group as compared to conventional care group (OR = 0.81, 95%CI [0.69,0.95]), while there was no significant difference at 7 days (OR = 0.88, 95%CI [0.68,1.15]). As regard achieving functional independence at 90 days (mRS = 0–2), MSU showed better results (OR = 1.24, 95%CI [1.03,1.49]). MSU was associated with shorter time from symptoms onset or LKW to thrombolysis (MD = ‐36.79, 95%CI [‐47.48, ‐26.10]) and alarm to IV thrombolysis or intra‐arterial recanalization (MD = ‐29.69, 95%CI [‐34.46, ‐24.92]). Conclusions Stroke patients treated in MSU had a lower incidence of the 90‐day mortality. They also had better functional independence at 90 days and time from symptom onset or LKW to thrombolysis than those treated with conventional care.

Introduction For more than three decades, robotic assisted surgery has been proposed, studied and put into action clinically. Likewise, it was cleared by the Food and Drug Administration for percutaneous coronary intervention in 2012 (K120834) and peripheral vascular intervention including carotid intervention in 2018 (K173288), but has not yet received clearance for intracranial neurovascular intervention in the USA. Recently, several pilot clinical studies assessed robotically performed neurointerventions. Methods We performed comprehensive electronic search till July 2022 on PubMed/Medline to retrieve all relevant studies and data were extracted for baseline characteristics, design, procedure type, safety and feasibility outcomes for qualitative synthesis. Results Our results yielded nine single center studies in UK, USA and China performed since 2015. The performed procedures included diagnostic cerebral angiography (36 patients), caroti aartery stenting (37 patients), unspecified robotic assisted intracranial intervention (18 patients) and stent‐assisted coil embolization of a basilar artery aneurysm (one case). The used robotic systems included Corpath GRX (5 studies), Magellan (2 studies), RobEnt (one study) and VIR‐2 (one study). The robotic assisted neurointervention was successful clinically without complications across all studies and for all procedures. The learning curve sounded promising but there were limitations in the design of systems for completing all steps robotically. Conclusions Robotics assisted procedures appear to be feasible and safe in neuro‐intevention field. Advantages include high accuracy, stability, safety, simplicity, versatility, monitoring, endothelial protection, and potential for remote access for procedures such as mechanical thrombectomy for acute ischemic stroke. However, there are many challenges including cost, manual steps, lack of manual resistance feeling, irrationality in the spatial arrangement of the robotic system and operating table. Additionally, most of the included studies were retrospective with small sample size and short term follow up and more well‐designed comparative prospective studies are needed to confirm these results.