Atieh, Fatima

Introduction Mechanical thrombectomy (MT) is a well‐established treatment for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, its role in cervical artery dissection‐related (CeAD) LVO remains debated due to anatomical complexities and procedural challenges. This systematic review and meta‐analysis aims to evaluate the safety, efficacy, and clinical outcomes of MT in patients with AIS due to CeAD‐related LVO, compared with other AIS etiologies. Methods PubMed, Embase, and Scopus were systematically searched from inception through March 2025. Comparative observational studies evaluating the use of MT in adult patients with AIS due to LVO were included, specifically those comparing outcomes in those with CeAD versus non‐CeAD etiologies. Most studies were retrospective and multicentric. Eligible interventions included stent retriever thrombectomy, direct aspiration (ADAPT), or combined approaches. Results Nine studies with a total of 4889 patients were included, comprising 446 CeAD‐related and 4443 non‐CeAD LVO cases. MT for CeAD‐related AIS showed no statistically significant difference in successful recanalization compared with non‐CeAD cases (OR:0.81, CI: [0.63,1.04], p=0.10). However, CeAD patients had significantly higher rates of 90‐day functional independence (mRS 0‐2) (OR:2.17, CI: [1.55, 3.05], p < 0.0001) and lower 90‐day mortality (OR:0.34, CI: [0.22, 0.53], p < 0.0001). Rates of distal embolization (OR:1.60, CI: [0.69, 3.70], p = 0.27), symptomatic ICH (OR:0.84, CI: [0.51, 1.38], p=0.49), or iatrogenic dissection (OR:1.58, CI: [0.59, 4.22], p=0.36) did not differ significantly. Conclusions Mechanical thrombectomy in CeAD‐related LVO is safe and associated with clinical outcomes comparable to patients with non‐CeAD acute ischemic causes. They demonstrated a similar patient safety profile, such as functional outcomes and mortality.

Background Mechanical thrombectomy (MT) is a well-established treatment for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, its role in cervical artery dissection-related (CeAD) LVO remains debated due to anatomical complexities and procedural challenges. This systematic review and meta-analysis aims to evaluate the safety, efficacy, and clinical outcomes of MT in patients with AIS due to CeAD-related LVO compared with other AIS etiologies. Methods PubMed, Embase, and Scopus were systematically searched from inception to March 2025. Comparative observational studies evaluating the use of MT in adult patients with AIS due to LVO were included, specifically those comparing outcomes in patients with CeAD versus non-CeAD etiologies. Results MT for CeAD-related AIS showed no statistically significant difference in successful recanalization compared with non-CeAD cases (OR 0.81 (95% CI 0.63 to 1.04), P=0.10). However, patients with CeAD-related AIS had significantly higher rates of 90-day functional independence (modified Rankin Scale score 0–2) (OR 2.17 (95% CI 1.55 to 3.05), P<0.01) and lower 90-day mortality (OR 0.34 (95% CI 0.22 to 0.53), P<0.01). Rates of distal embolization (OR 1.60 (95% CI 0.69 to 3.70), P=0.27), symptomatic intracranial hemorrhage (OR 0.84 (95% CI 0.51 to 1.38), P=0.49), or iatrogenic dissection (OR 1.58 (95% CI 0.59 to 4.22), P=0.36) did not differ significantly between patient groups. Conclusions MT in patients with CeAD-related LVO is safe, effective, and associated with improved functional outcomes and lower mortality compared with patients with non-CeAD acute ischemic causes.