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Chen Y.,Nanjing Medical University | Guan J.-J.,Nanjing Medical University | Liu A.-H.,Nanjing Medical University | Ding H.,Nanjing Medical University | And 4 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2014

Objective The purpose of this meta-analysis is to compare clinical outcomes between endovascular treatment and conservative treatment for cervicocranial artery dissection. Methods Medline, Embase, and Cochrane Library databases were searched for studies comparing endovascular treatment versus conservative treatment for cervicocranial artery dissection patients. The period searched was from November 1994 to March 2013. Fifteen observational studies involving 442 cervicocranial artery dissection patients were found. Evaluated outcomes included rate of mortality, disability, and good recovery. The rebleeding rate in subarachnoid hemorrhage (SAH) patients was also recorded and compared. Results In general, patients who received endovascular treatment enjoyed a lower mortality rate than those who received conservative treatment (P =.02, odds ratio [OR]:.5, 95% confidence interval [CI]:.27-.90), especially patients having ruptured cervicocranial artery dissection (P =.002, OR:.32, 95% CI.15-.66) and dissecting aneurysms (P =.006, OR:.31, 95% CI.14-.71). Among SAH patients with a Hunt-Hess score of 3 or more, endovascular treatment decreased mortality significantly (P =.006, OR:.22, 95% CI.08-.65), whereas no significant differences between these 2 treatments occurred in patients having a Hunt-Hess score less than 3. Conclusions Endovascular treatment yields a better outcome, with greater benefit in patients with ruptured cervicocranial artery dissection, dissecting aneurysms, and a Hunt-Hess score of 3 or more. Randomized controlled trials comparing these 2 therapeutic strategies are needed. © 2014 by National Stroke Association. Source

Lin Y.-J.,Nanjing Medical University | Lin Y.-J.,Stroke Center for Diagnosis and Therapy in Jiangsu Province | Li J.-W.,Nanjing Medical University | Li J.-W.,Stroke Center for Diagnosis and Therapy in Jiangsu Province | And 14 more authors.
CNS Neuroscience and Therapeutics | Year: 2014

Aims: Preventing stroke through endovascular treatment with vertebral artery stent remains a great challenge due to the occurrence of an in-stent restenosis. Materials & Methods: In this study, a retrospective analysis was conducted in 90 patients who had been treated with VAS between 2004 and 2011 in Nanjing Drum Tower Hospital. Patients were followed up at 3 months, 6 months,and 1 year after VAS treatment and annually thereafter. For each time point, neurological function tests, vessel ultrasound and computer tomography angiography were performed to preliminarily screen the vessel stenosis. Digital subtraction angiography was used to verify the narrow sign on CTA or ultrasound. Clinical features of each patient including clopido-grel metabolization genes (CYP2C19, CYP3A4, and P2Y12) were recorded with purpose to investigate the possible risk factors for the development of ISR. Results: Single factor analysis dem-onstrated that hyperlipidemia (P < 0.05) and CYP2C19 (P < 0.01) loss-of-function geno-type increased the likelihood of ISR. A multiple logistic cox regression analysis also showed that stroke patients with hyperlipidemia (HR 3.719, 95% CI: 1.094-12.637, P = 0.035), and CYP2C19 loss-of-function genotype (HR 2.959, 95% CI: 1.325-6.610, P = 0.008) were more likely to suffer from ISR. Furthermore, CYP2C19 alleles were mainly divided into three groups: wt/wt (CYP2C19 *1/*1), wt/m (CYP2C19 *1/*2 and *1/*3), and m/m (CYP2C19 *2/*2,*2/*3 and*3/*3). Recurrent rate of ischemic stroke in m/m and wt/m groups was higher than the wt/wt group (OR: 0.141, 95% CI: 0.016-1.221, P = 0.042). Conclusion: The study leads to the conclusion that hyperlipidemia and CYP2C19 impotency are possible risk factors for the development of ISR in VAS-treated patients with ischemic. Moreover, VAS-treated patients with CYP2C19 impotency were susceptible to recurrent stroke during our 54-month follow-up. © 2013 John Wiley & Sons Ltd. Source

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