Clinical outcomes of patients with vertebral artery dissection treated endovascularly: a meta-analysis

The purpose of this study was to present a meta-analysis on the safety and efficacy of different endovascular modalities when treating vertebral artery dissections, since ideal treatment remains controversial. We performed a meta-analysis of 39 retrospective studies involving different treatment modalities for vertebral artery dissections in adults and obtained weighted pooled proportional outcome and mortality ratios with a random effects model. Overall, 75.11 % (confidence interval (CI) 68.89–80.84, I2 66.89 %) had excellent outcomes, 10.10 % (CI 6.83–15.56, I2 65.64 %) had good outcomes, and 13.70 % (CI 9.64–18.35, I2 60.33 %) had poor outcomes. Postoperative complications occurred in 10.52 % (CI 6.87–14.84, I2 62.48 %), with 2.73 % (CI 1.64–4.10, I2 0.0 %) exhibiting vasospasm, 3.03 % (CI 1.88–4.46, I2 0.0 %) experiencing postoperative rebleeding, and 6.31 % (CI 3.57–9.76, I2 60.92 %) showing ischemia. Overall mortality was 8.69 % (CI 6.13–11.64, I2 33.76 %). When compared to these overall ratios, different treatment modality subgroups did not differ significantly, except for the proximal occlusion group, with poor outcome ratio = 26.96 % (difference 13.26, CI 0.02–30.04, p = 0.0403) and mortality ratio = 21.36 % (difference 12.67, CI 0.94–28.86, p = 0.0189). Different endovascular treatment modalities are comparatively safe and effective in the management of vertebral artery dissection. Their reduced operative time, minimal invasiveness, and overall safety render them a suitable option for intervention-amenable dissections.