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Updated: Sep 27, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular and Antithrombotic Treatment in Blunt Cerebrovascular Injuries: A Systematic Review and Meta-Analysis
Stefano M Priola1, Jerry C Ku2, Paolo Palmisciano3
1Division of Neurosurgery, Department of Surgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada; Division of Trauma Surgery, Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, Humanitas Centro Catanese di Oncologia, Catania, Italy.
Insights
Antithrombotic therapy (AT) and endovascular treatment (ET) appear comparable for preventing ischemic stroke after blunt cerebrovascular injury (BCVI). AT may be preferred due to its less invasive nature, though ET offers good outcomes with low complications.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Blunt cerebrovascular injury (BCVI) carries a significant risk of ischemic stroke, estimated up to 26%.
- Antithrombotic therapy (AT) is used for stroke prevention, but the efficacy of endovascular treatment (ET) for BCVI remains uncertain.
- Systematic review and meta-analysis are needed to compare AT and ET in BCVI patients.
Purpose of the Study:
- To systematically review the literature on antithrombotic therapy (AT) and endovascular treatment (ET) for blunt cerebrovascular injury (BCVI).
- To compare the effectiveness of AT versus ET in preventing post-BCVI ischemic strokes.
- To assess neurologic outcomes, radiographic responses, and complication rates associated with ET in BCVI.
Main Methods:
- Searched PubMed, EMBASE, Web of Science, and Cochrane databases following PRISMA guidelines.
- Included 16 studies with 352 patients undergoing ET for BCVI.
- Performed a fixed-effect model meta-analysis comparing ischemic stroke rates between AT and ET protocols.
Main Results:
- Endovascular treatment (ET) in BCVI patients showed high rates of good neurologic outcomes (86.9%) and radiologic response (94.0%), with a 5.2% complication rate.
- Meta-analysis of 7 studies found no significant difference in post-BCVI ischemic stroke rates between AT (805 patients) and ET (235 patients) (OR 0.71, p=0.402).
- Both AT and ET demonstrated comparable efficacy in preventing ischemic stroke following BCVI.
Conclusions:
- Antithrombotic therapy (AT) and endovascular treatment (ET) may be comparable in preventing ischemic stroke after blunt cerebrovascular injury (BCVI).
- AT is a less invasive first-line option, while ET demonstrates favorable clinical and radiologic outcomes with low complication rates.
- Further research may clarify optimal treatment strategies for BCVI patients at risk of stroke.
Objectives:
Ischemic stroke has been estimated to occur in up to 26% of patients with blunt cerebrovascular injury (BCVI). Antithrombotic therapy (AT) may be used for stroke prevention, but the role of endovascular treatment (ET) remains unclear. We systematically reviewed the literature on AT and ET for the treatment of patients with BCVIs.
Materials And Methods:
PubMed, EMBASE, Web of Science, and Cochrane were searched upon the PRISMA guidelines to include studies reporting the use of ET in BCVI patients. Post-ET neurologic outcomes, radiographic responses, and complication rates were assessed. A fixed-effect model meta-analysis was performed to compare treatment-related post-BCVI ischemic stroke rates between AT and ET protocols.
Results:
We included 16 studies comprising 352 patients undergoing ET for BCVI. Mean post-ET rates of good neurologic outcomes and radiologic responses were 86.9% (range, 63.6-100%) and 94.0% (range 57.1-100%), respectively. Mean post-ET complication rate was 5.2% (range, 0-66.7%). Seven studies compared the roles of AT (delivered in 805 patients) and ET (performed in 235 patients) for preventing the onset of post-BCVI ischemic strokes. No significant difference in rates of post-BCVI ischemic stroke was found between patients receiving AT vs patients undergoing ET (OR 0.71, 95% CI: 0.35-1.42, p = 0.402).
Conclusion:
AT and ET may be comparable in preventing the occurrence of ischemic stroke following BCVIs. AT may be preferred as the less-invasive first-line therapy, but ET showed favorable rates of post-treatment clinical and radiologic outcomes, coupled with low rates of treatment-related complications.
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