Systematic review and meta-analysis finds no significant link between styloid process anatomy and internal carotid artery dissection overall
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Key Takeaway
Note that overall meta-analysis shows no significant link between styloid process anatomy and ICA-D.
This systematic review and meta-analysis investigates the relationship between styloid process characteristics and internal carotid artery dissection. The authors analyzed data from 270 ICA-D patients and 377 controls to assess associations with styloid process length, angulation, and distance from the internal carotid artery. The primary outcome focused on the association between SP-ICA distance and ICA-D across all five included case-control studies.
The pooled analysis for SP-ICA distance showed no significant difference between groups with a standardized mean difference of -0.92 and a p-value of 0.143. However, a subgroup analysis of moderate-to-high quality studies indicated a negative pooled SMD of -0.29, consistent with a shorter SP-ICA distance in ICA-D cases, with a p-value of 0.047 derived from four studies.
Regarding secondary outcomes, SP length showed no significant association with a standardized mean difference of 0.24 and a p-value of 0.139 based on three studies. No significant relationship was found for SP angulation in two studies, as the effect size and p-values were not reported. The authors note that available evidence remains limited and heterogeneous.
The study does not report safety data, adverse events, or funding sources. The authors caution that the evidence is observational and describes an association rather than causality. Practice relevance was not reported in the source material.
View Original Abstract ↓
PurposeInternal carotid artery dissection (ICA-D) is an important cause of stroke in adults. The styloid process (SP) may be associated with ICA-D due to potential (micro)trauma resulting from its close anatomical proximity to the internal carotid artery (ICA). The aim of this systematic review with meta-analysis is to investigate the association between SP characteristics –particularly SP-ICA distance – and ICA-D.MethodsA systematic review was conducted across six databases to identify observational studies comparing ICA-D patients to controls. The primary outcome of interest was the association between SP-ICA distance and ICA-D. Secondary outcomes included associations between ICA-D and the SP length or angulation. A random-effects meta-analysis was performed, including a subgroup analysis of moderate/high-quality studies. Effect sizes were expressed as standardized mean differences (SMD, Hedges' g).ResultsSix studies were included in the systematic review, of which five were eligible in the meta-analysis. The pooled analysis of all five case-control studies (270 ICA-D patients and 377 controls) showed no significant difference in SP-ICA distance (SMD = −0.92, p = 0.143); with a high degree of heterogeneity (I2 = 98%). Subgroup analysis of moderate/high-quality studies evaluating the SP-ICA distance ipsilateral to the ICA-D (4 studies) yielded a negative pooled SMD (−0.29, p = 0.047; moderate heterogeneity: I2 = 64%), consistent with a shorter SP-ICA distance in ICA-D cases. Meta-analysis of the SP length (3 studies) found no significant association (SMD 0.24, p = 0.139) and two studies also found no significant relationship between ICA-D and SP angulation.ConclusionA shorter SP–ICA distance was associated with ICA-D, whereas no significant associations were observed for SP length or angulation. However, the available evidence remains limited and heterogeneous.Systematic Review RegistrationCRD42024582594
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