Clinical predictors of delayed cerebral ischemia after subarachnoid hemorrhage: first experience with coil embolization in the management of ruptured cerebral aneurysms

Kawabata, Yasuhiro; Horikawa, Fumihiko; Ueno, Yasushi; Sawada, Masahiro; Isaka, Fumiaki; Miyake, Hidenori

doi:10.1136/jnis.2010.004077

Cited by 5 publications

(2 citation statements)

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“…Eight studies with 1868 patients reported the rebleeding rate at discharge [ 8 , 17 , 20 , 25 , 42 , 43 , 59 , 60 ]. Consequently, clipping was associated with an approximately 48% decrease in the risk of rebleeding compared to coiling (RR: 0.52, 95% CI: 0.29–0.94, P = 0.03, Supplemental Fig.…”

Section: Resultsmentioning

confidence: 99%

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Clipping versus coiling for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of prospective studies

et al. 2021

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Neurosurgical clipping and endovascular coiling are both standard therapies to prevent rebleeding after aneurysmal subarachnoid hemorrhage (aSAH). However, controversy still exists about which is the optimal treatment. This meta-analysis aims to assess the effectiveness and safety of two treatments with high-quality evidence. Web of Science, Cochrane Library, EMBASE, Pubmed, Sinomed, China National Knowledge Infrastructure, and Wanfang Data databases were systematically searched on August 5, 2021. Randomized controlled trials (RCTs) and prospective cohort studies that evaluated the effectiveness and safety of clipping versus coiling in aSAH patients at discharge or within 1-year follow-up period were eligible. No restriction was set on the publication date. Meta-analyses were conducted to calculate the pooled estimates and 95% confidence intervals (CI) of relative risk (RR). Eight RCTs and 20 prospective cohort studies were identified. Compared to coiling, clipping was associated with a lower rebleeding rate at discharge (RR: 0.52, 95% CI: 0.29––0.94) and a higher aneurysmal occlusion rate (RR: 1.33, 95% CI: 1.19–1.48) at 1-year follow-up. In contrast, coiling reduced the vasospasm rate at discharge (RR: 1.45, 95% CI: 1.23–1.71) and 1-year poor outcome rate (RR: 1.27, 95% CI: 1.16–1.39). Subgroup analyses presented that among patients with a poor neurological condition at admission, no statistically significant outcome difference existed between the two treatments. The overall prognosis was better among patients who received coiling, but this advantage was not significant among patients with a poor neurological condition at admission. Therefore, the selection of treatment modality for aSAH patients should be considered comprehensively.

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Section: Resultsmentioning

confidence: 99%

“…The representativeness of the cohort was low in 5 studies because they did not include consecutive or random samples [2,16,28,52,60]. Seven studies did not state clearly how they assessed the outcomes [3,12,16,25,46,56,60]. The methodological scores of each cohort are presented in Table 2.…”

Section: The Methodological Quality Of the Included Studiesmentioning

confidence: 99%

Clipping versus coiling for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of prospective studies

et al. 2021

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Blood Pressure Management in Intracranial Hemorrhage: Current Challenges and Opportunities

Carcel

Sato

Anderson

2016

Curr Treat Options Cardio Med

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Non-traumatic intracranial hemorrhage (i.e. intracerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]) are more life threatening and least treatable despite being less common than ischemic stroke. Elevated blood pressure (BP) is a strong predictor of poor outcome in both ICH and SAH. Data from a landmark clinical trial INTERACT 2, wherein 2839 participants enrolled with spontaneous ICH were randomly assigned to receive intensive (target systolic BP <140 mmHg) or guideline recommended BP lowering therapy (target systolic BP <180 mmHg), showed that intensive BP lowering was safe, and more favorable functional outcome and better overall health-related quality of life were seen in survivors in the intensive treatment group. These results contributed to the shift in European and American guidelines towards more aggressive early management of elevated BP in ICH. In contrast, the treatment of BP in SAH is less well defined and more complex. Although there is consensus that hypertension needs to be controlled to prevent rebleeding in the acute setting, induced hypertension in the later stages of SAH has questionable benefits.

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Predictors of Severity of Cerebral Vasospasm caused by Aneurysmal Subarachnoid Hemorrhage

Jabbarli

Gläsker

Weber

et al. 2013

Journal of Stroke and Cerebrovascular Diseases

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Clinical predictors of delayed cerebral ischemia after subarachnoid hemorrhage: first experience with coil embolization in the management of ruptured cerebral aneurysms

Abstract: DCI was less frequently observed in the coiling group, and clinical outcomes were also superior in the coiling group, especially for patients with severe SAH. The results showed a significant correlation between DCI and hydrocephalus.

Cited by 5 publications

References 32 publications

Clipping versus coiling for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of prospective studies

Clipping versus coiling for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of prospective studies

Blood Pressure Management in Intracranial Hemorrhage: Current Challenges and Opportunities

Predictors of Severity of Cerebral Vasospasm caused by Aneurysmal Subarachnoid Hemorrhage

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