Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis

Abstract

Introduction Management of intracranial artery dissection (IAD) remains elusive in medical practice. Intracranially, vertebral artery dissection (VAD) is more commonly encountered than internal carotid artery dissection (ICAD). Deconstructive (EVT-d) and reconstructive (EVT-r) endovascular techniques have been utilized to treat VAD and ICAD. This meta-analysis investigates the safety and efficacy of EVT-r and EVT-d in the management of VAD and ICAD. Methods The literature was searched for all studies with consecutive patient series evaluating EVT-d or EVT-r for VAD or ICAD management. Baseline characteristics and outcomes were compared between EVT-r and EVT-d groups using the random-effect model and meta-regression approaches. Results Overall, 1095 cases pooled from 56 studies were included. There was no statistically significant difference in baseline characteristics between VAD and ICAD. EVT-r was applied in 647 cases (59.1%) and EVT-d in the rest There was no statistical difference in the rate of procedural complications between EVT-r and EVT-d. Although EVT-d was significantly associated with higher rates of complete aneurysm occlusion (86.4%), lower rates of good clinical outcomes (72.1%) and higher mortality (15.1%) were achieved compared to EVT-r (70.2%, 83.3%, and 9.5%; respectively). The mortality rate was higher, and good clinical outcomes were less common in ruptured aneurysms. Ischemic presentation was statistically associated with poor outcomes (mRS 3-5) but low mortality. ICAD often tended to grow following treatment and resulted in poor neurological outcomes. Conclusions IAD has favorable outcomes when treated appropriately. Novel reconstructive endovascular techniques are promising and should be integrated well in endovascular practice. Further studies are warranted.

Sudden unilateral hearing loss and vertigo following isolated cerebellar hypoperfusion without infarction due to vertebral artery dissection

“…The randomized CADISS clinical trial showed no significant difference between antiplatelet and anticoagulant treatments in rates of further ischaemic stroke, subarachnoid haemorrhage, and death at 3 months [ 22 ]. To date, symptomatic intracranial artery dissection, including vertebral artery dissection, is a significant challenge for clinicians due to the evidence of poor clinical outcomes and limited conservative and interventional management [ 23 ]. Since the introduction of endovascular treatments for intracranial artery dissection two decades ago, it has evolved from simple coiling or balloon occlusion for parent arterial sacrifice to more selective and delicate reconstruction styles, including overlapping stents, stent-assisted coils, and flow diverters [ 23 ].…”

“…To date, symptomatic intracranial artery dissection, including vertebral artery dissection, is a significant challenge for clinicians due to the evidence of poor clinical outcomes and limited conservative and interventional management [ 23 ]. Since the introduction of endovascular treatments for intracranial artery dissection two decades ago, it has evolved from simple coiling or balloon occlusion for parent arterial sacrifice to more selective and delicate reconstruction styles, including overlapping stents, stent-assisted coils, and flow diverters [ 23 ]. As reported in a previous meta-analysis, deconstructive treatments were commonly utilized for vertebrobasilar dissections with good angiographic outcomes [ 24 ].…”