The study languages were restricted to English and Chinese. We used the following combination of variables: (‘carotid artery dissection' or ‘vertebral artery dissection' or ‘cervical artery dissection') and (‘stroke' or ‘brain ischemia' or ‘brain infarction') and (‘thrombolysis' or ‘recombinant tissue plasminogen activator' or ‘rtPA' or ‘tissue plasminogen activator' or ‘tPA' or ‘urokinase' or ‘pro-urokinase'). We systematically searched PubMed, Web of Science, EMBASE, Cochrane Library, CNKI database up to May 2015. The aim of this meta-analysis was to assess the safety and efficacy of thrombolysis in CAD-related ischemic stroke by evaluating all available observational studies. As the pathogenesis of CAD is associated with a high risk of thrombolysis, the safety and efficacy of thrombolysis in this group of patients have been a matter of intense debate.
In theory, there is a danger that thrombolysis may increase the risk of enlargement of an intramural hematoma in the dissected artery and cause local complications or further impair the cerebral circulation. On the other hand, CAD consists of internal carotid artery dissection and vertebral artery dissection, which is caused by the presence of disturbed hemodynamics and abnormalities in the structure of arterial wall. In fact, the guideline for CAD does not exclude thrombolysis and randomized controlled trials that have investigated thrombolysis in acute ischemic have not excluded patients with CAD. At present, many studies have indicated that thrombolysis may improve the prognosis by restoring perfusion of cerebral blood flow it is safe and effective in acute ischemic stroke. In fact, CAD is a major cause in stroke of young people, for example, in patients under the age of 50, CAD is a rather common cause of stroke, accounting for 10-25% of all ischemic strokes. Cervical artery dissection (CAD) can lead to occlusion of the artery and it has been estimated that 2% of all ischemic strokes are caused by CAD. The incidence of stroke has been on the rise in recent years, especially stroke in younger individuals. However, this will need to be confirmed in large-scale randomized studies, especially involving intravenous thrombolysis treatment. Therefore, CAD patients experiencing a stroke should not be denied thrombolysis therapy. It is also as effective as thrombolysis in stroke from miscellaneous causes.
Conclusion: Thrombolysis seems to be equally safe and will achieve an efficacy similar to the efficacy of non-thrombolysis in patients with acute ischemic stroke due to CAD. ICH rate was higher in the thrombolysis group of CAD-related stroke patients compared to that in the non-thrombolysis group (12.3 vs. There was no significant difference in SICH, mortality and recurrent stroke rates between the 2 groups (all p > 0.05). 58.2%, OR 0.782, χ 2 = 0.594, p > 0.05) non-thrombolysis was slightly superior than thrombolysis in terms of excellent outcome (52.4 vs. The meta-analysis detected no significant statistical difference in the proportion of CAD-related stroke patients enjoying a favorable outcome at the 3 months' follow-up between the thrombolysis and non-thrombolysis groups (53.7 vs. Results: A total of 846 patients were identified from 10 studies (174 with thrombolysis 672 with non-thrombolysis).
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The difference of outcomes and adverse events between the 2 groups was compared by analyzing the pooled OR value and chi-square test using the software SPSS. The meta-analysis models in Comprehensive Meta-Analysis V2 software were applied to calculate the merged rates of favorable outcome (modified Rankin Scale, mRS 0-2), excellent outcome (mRS 0-1), intracranial hemorrhage (ICH), symptomatic ICH (SICH), mortality and recurrent stroke between thrombolysis and non-thrombolysis in CAD-related stroke. Methods: We performed a systematic search of the efficacy of thrombolysis treatment in CAD-related ischemic stroke with appropriate observational studies identified for the study. The aim of this meta-analysis was to assess observational data related to the safety and efficacy of thrombolysis in CAD-related ischemic stroke. Background: Although thrombolysis is considered to be the first-line treatment for ischemic stroke, there remains an ongoing controversy on the safety and efficacy of thrombolysis in cervical artery dissection (CAD).
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