Reperfusion strategies in stroke due to isolated cervical internal carotid artery occlusion: systematic review and treat
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ORIGINAL ARTICLE
Reperfusion strategies in stroke due to isolated cervical internal carotid artery occlusion: systematic review and treatment comparison Michele Romoli 1,2 & Maria Giulia Mosconi 3 & Patrizia Pierini 3 & Andrea Alberti 3 & Michele Venti 3 & Valeria Caso 4 & Simone Vidale 2 & Enrico Maria Lotti 2 & Marco Longoni 4 & Paolo Calabresi 5,6 & Georgios Tsivgoulis 7,8 & Maurizio Paciaroni 3 Received: 1 June 2020 / Accepted: 17 September 2020 # The Author(s) 2020
Abstract Introduction Despite intravenous thrombolysis (IVT) and endovascular treatment (EVT) have been demonstrated effective in acute ischemic stroke (AIS) due to large vessel occlusions, there are still no conclusive data to guide treatment in stroke due to cervical internal carotid artery (ICA) occlusion. We systematically reviewed available literature to compare IVT, EVT, and bridging (IVT + EVT) and define optimal treatment. Methods Systematic review followed predefined protocol (Open-Science-Framework osf.io/bfykj). MEDLINE, EMBASE, and Cochrane CENTRAL were searched. Results were restricted to studies in English, with sample size ≥ 10 and follow-up ≥30 days. Primary outcomes were favorable outcome (mRS ≤ 2), mortality, and symptomatic intracerebral hemorrhage(sICH), defined according to study original report. Newcastle-Ottawa scale was used for bias assessment. Results Seven records of 930 screened were included in meta-analysis. Quality of studies was low-to-fair in 5, good in 2. IVT (n = 450) did not differ for favorable outcome and mortality compared to EVT (n = 150), though having lower rate of sICH (OR = 0.4, 95% CI 0.2–0.8). Compared to IVT, bridging (IVT + EVT) was associated with higher rate of favorable outcome (OR = 2.2, 95% CI 1.3–3.7). Compared to EVT, bridging (IVT + EVT) provided higher rate of favorable outcome (OR = 1.9, 95% CI 1.1– 3.4), with a marginally increased risk of sICH (OR = 2.1, 95% CI 1–4.4) but similar mortality rates. Conclusions Our systematic review highlights that, in acute ischemic stroke associated with isolated cervical ICA occlusion, bridging (IVT + EVT) might lead to higher rate of functional independence at follow-up, without increasing mortality. The low quality of available studies prevents from drawing firm conclusions, and randomized-controlled clinical trials are critically needed to define optimal treatment in this AIS subgroup.
Michele Romoli and Maria Giulia Mosconi are First authors Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10072-020-04735-5) contains supplementary material, which is available to authorized users. * Michele Romoli [email protected]; [email protected] 1
Neurology Clinic, University of Perugia–S. Maria della Misericordia Hospital, Perugia, Italy
2
Neurology Unit, Rimini “Infermi” Hospital–AUSL Romagna, Viale Settembrini 2, 47923 Rimini, Italy
3
Stroke Unit and Division of Cardiovascular Medicine, University of Perugia–S. Maria della Misericordia Hospital, Perugia, Italy
4
Neurology Unit, “M.
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