Association of asymptomatic cerebral vasospasm with outcomes in survivors of aneurysmal subarachnoid hemorrhage

Shamshad, Alizeh; Persad-Paisley, Elijah M.; Wendell, Linda C.; Thompson, Bradford B.; Reznik, Michael; Furie, Karen L.; Mahta, Ali

doi:10.1016/j.jstrokecerebrovasdis.2022.106821

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…In our opinion, this choice makes the comparisons among studies more homogenous. Additionally, it is important to note that asymptomatic vasospasm does not have the same negative impact on outcomes as symptomatic vasospasm [115], so its relevance to clinical practice may not be as significant. Nevertheless, consistent with the previous findings, we found a higher risk for DCI among women than men.…”

Section: Results In Contextmentioning

confidence: 99%

Sex-Related Differences in Mortality, Delayed Cerebral Ischemia, and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Berli,

Barbagallo,

Keller

et al. 2024

JCM

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Background/Objective: Sex-related differences among patients with aneurysmal subarachnoid hemorrhage (aSAH) and their potential clinical implications have been insufficiently investigated. To address this knowledge gap, we conduct a comprehensive systematic review and meta-analysis. Methods: Sex-specific differences in patients with aSAH, including mortality, delayed cerebral ischemia (DCI), and functional outcomes were assessed. The functional outcome was dichotomized into favorable or unfavorable based on the modified Rankin Scale (mRS), Glasgow Outcome Scale (GOS), and Glasgow Outcome Scale Extended (GOSE). Results: Overall, 2823 studies were identified in EMBASE, MEDLINE, PubMed, and by manual search on 14 February 2024. After an initial assessment, 74 studies were included in the meta-analysis. In the analysis of mortality, including 18,534 aSAH patients, no statistically significant differences could be detected (risk ratio (RR) 0.99; 95% CI, 0.90–1.09; p = 0.91). In contrast, the risk analysis for DCI, including 23,864 aSAH patients, showed an 11% relative risk reduction in DCI in males versus females (RR, 0.89; 95% CI, 0.81–0.97; p = 0.01). The functional outcome analysis (favorable vs. unfavorable), including 7739 aSAH patients, showed a tendency towards better functional outcomes in men than women; however, this did not reach statistical significance (RR, 1.02; 95% CI, 0.98–1.07; p = 0.34). Conclusions: In conclusion, the available data suggest that sex/gender may play a significant role in the risk of DCI in patients with aSAH, emphasizing the need for sex-specific management strategies.

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Section: Results In Contextmentioning

confidence: 99%

Sex-Related Differences in Mortality, Delayed Cerebral Ischemia, and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Berli,

Barbagallo,

Keller

et al. 2024

JCM

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“…In addition, treatment will influence the development of DCI. It is known that vasospasm or high flow velocities do not necessarily lead to DCI and that DCI can also occur without vasospasm [ 6 , 24 , 25 ].The clinical characteristics rWFNS, SAFIRE grade, and ventricular drainage were associated with occurrence of DCI. The presence of a CSF drain after treatment was more common in patients with DCI, but this was probably explained by the fact that these patients were in a worse clinical condition.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of transcranial doppler to predict delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

van der Harst,

Elting,

Hijlkema

et al. 2024

Acta Neurochir

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Background Transcranial Doppler (TCD) is a technique to assess blood flow velocity in the cerebral arteries. TCD is frequently used to monitor aneurysmal subarachnoid hemorrhage (aSAH) patients. This study compares TCD-criteria for vasospasm and its association with Delayed Cerebral Ischemia (DCI). An overall score based on flow velocities of various intracranial arteries was developed and evaluated. Methods A retrospective diagnostic accuracy study was conducted between 1998 and 2017 with 621 patients included. Mean flow velocity (MFV) of the cerebral artery was measured between 2–5 days and between 6–9 days after ictus. Cutoff values from the literature, new cutoff values, and a new composite score (Combined Severity Score) were used to predict DCI. Sensitivity, specificity, and area under the curve (AUC) were determined, and logistic regression analysis was performed. Results The Combined Severity Score showed an AUC 0.64 (95%CI 0.56-.71) at days 2–5, with sensitivity 0.53 and specificity 0.74. The Combined Severity Score had an adjusted Odds Ratio of 3.41 (95CI 1.86–6.32) for DCI. MCA-measurements yielded the highest AUC to detect DCI at day 2–5: AUC 0.65 (95%CI 0.58–0.73). Optimal cutoff MFV of 83 cm/s for MCA resulted in sensitivity 0.73 and specificity 0.50 at days 2–5. Conclusion TCD-monitoring of aSAH patients may be a valuable strategy for DCI risk stratification. Lower cutoff values can be used in the early phase after the ictus (day 2–5) than are commonly used now. The Combined Severity Score incorporating all major cerebral arteries may provide a meaningful contribution to interpreting TCD measurements.

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Transcranial Doppler (TCD): Clinical Applications in Acute Brain Injury

Rynkowski,

Caldas,

Taccone

2023

Lessons From the ICU

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Association of asymptomatic cerebral vasospasm with outcomes in survivors of aneurysmal subarachnoid hemorrhage

Cited by 3 publications

References 19 publications

Sex-Related Differences in Mortality, Delayed Cerebral Ischemia, and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Sex-Related Differences in Mortality, Delayed Cerebral Ischemia, and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Diagnostic value of transcranial doppler to predict delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Transcranial Doppler (TCD): Clinical Applications in Acute Brain Injury

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