Risk Prediction of Cerebrovascular Ischemic Events Following Cervical Artery Dissections Using High-Intensity Transient Signals: A Systematic Review, Meta-Analysis and a single center experience.

IF 2.8 Q3 CLINICAL NEUROLOGY
Stroke (Hoboken, N.J.) Pub Date : 2025-05-01 Epub Date: 2025-03-08 DOI:10.1161/SVIN.124.001704
Seyed Behnam Jazayeri, Behnam Sabayan, Yasaman Pirahanchi, Vikas Ravi, Julián Carrión-Penagos, Jeffery Bowers, Royya Modir, Kunal Agrawal, Thomas Hemmen, Brett Meyer, Dawn Meyer, Reza Bavarsad Shahripour
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Abstract

Background: Predicting and managing spontaneous Cervical Artery Dissections (CeAD) is challenging due to the absence of tools for early identification of high-risk individuals. This study seeks to gather evidence on the predictive value of high-intensity transient signals (HITS) detected by Transcranial Doppler for recurrent ischemic events (IEs) following CeAD.

Methods: We performed a systematic review and meta-analysis of published studies along with the data from our cohort. Following PRISMA guidelines, we searched Pubmed, Embase and Scopus to identify studies that evaluated HITS in patients with CeAD with the aim of predicting IEs. Data were pooled using a random effects model, with odds ratio (OR) and its 95% confidence interval (CI) as the effect size. Heterogeneity was assessed with the Q statistic and I2 test, while subgroup analysis evaluated the impact of dissected artery (carotid vs vertebral) on the relationship between HITS and ischemic events. Our retrospective study included consecutive patients diagnosed with CeAD, followed for 90 days to record IEs. Univariable and multivariable analyses were performed to identify factors associated with recurrent TIAs or strokes within 90 days post-CeAD.

Results: Our systematic review included five prior studies, which, combined with our center's sample size, provided data for a total of 306 patients. The meta-analysis indicated that HITS is a significant predictor of IEs (OR: 13.25, 95% CI [2.97-59.13], p<0.01) with low heterogeneity (I2 = 42%, p = 0.13). However, subgroup analysis indicated that HITS are a significant predictor only for carotid artery dissections (p<0.01), and not for vertebral artery dissections (p=0.11). The cohort consisted of 34 patients (mean age: 46.8 years, 55.9% male). The incidence of IEs was 20% in our cohort and all of them (100%) had HITSs in TCD. In multivariable analysis, the presence of HITS (p=0.006) and intra-luminal thrombosis (p=0.02) were significant predictors of IEs.

Conclusions: The presence of HITS detected by TCD is a strong predictor of IEs in patients with Carotid artery dissections. This highlights the clinical value of TCD in identifying high-risk patients and emphasizes the need for proactive management strategies to reduce the risk of future IEs in this subgroup.

利用高强度瞬态信号预测颈动脉夹层后脑血管缺血事件的风险:系统综述、meta分析和单中心经验
背景:由于缺乏早期识别高风险个体的工具,预测和管理自发性颈动脉夹层(CeAD)具有挑战性。本研究旨在收集经颅多普勒检测高强度瞬态信号(HITS)对脑卒中后复发性缺血事件(IEs)的预测价值的证据。方法:我们对已发表的研究以及我们队列的数据进行了系统回顾和荟萃分析。根据PRISMA指南,我们检索了Pubmed、Embase和Scopus,以确定评估颅内血管病患者hit的研究,目的是预测IEs。采用随机效应模型合并数据,以优势比(OR)及其95%置信区间(CI)为效应量。采用Q统计和I2检验评估异质性,而亚组分析评估了夹层动脉(颈动脉与椎动脉)对HITS与缺血性事件之间关系的影响。我们的回顾性研究包括连续诊断为CeAD的患者,随访90天以记录IEs。进行单变量和多变量分析以确定与脑卒中后90天内复发性tia或卒中相关的因素。结果:我们的系统综述纳入了5项先前的研究,结合我们中心的样本量,总共提供了306例患者的数据。荟萃分析显示,HITS是IEs的重要预测因子(OR: 13.25, 95% CI[2.97-59.13])。结论:TCD检测到HITS的存在是颈动脉夹层患者IEs的一个强有力的预测因子。这突出了TCD在识别高危患者方面的临床价值,并强调了前瞻性管理策略的必要性,以降低该亚组未来发生IEs的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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