Controversies in the management of aneurysmal subarachnoid hemorrhage*

Naval, Neeraj S.; Stevens, Robert; Mirski, Marek A.; Bhardwaj, Anish

doi:10.1097/01.ccm.0000198331.45998.85

Cited by 82 publications

(36 citation statements)

References 139 publications

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“…298 -300 Uncontrolled studies using crystalloid or colloid agents suggest that aggressive volume resuscitation can ameliorate the effect of cerebral salt wasting on the risk of cerebral ischemia after aSAH. 301,302 One retrospective study has suggested that 3% saline solution is effective in correcting hyponatremia in this setting. 303 In addition, use of hypertonic saline solution appears to increase regional cerebral blood flow, brain tissue oxygen, and pH in patients with high-grade aSAH.…”

Section: Management Of Medical Complications Associated With Asahmentioning

confidence: 99%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Connolly¹,

Rabinstein²,

Carhuapoma³

et al. 2012

Stroke

2,883

1,375

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Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods— A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. Results— Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. Conclusions— aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.

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Section: Management Of Medical Complications Associated With Asahmentioning

confidence: 99%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Connolly¹,

Rabinstein²,

Carhuapoma³

et al. 2012

Stroke

2,883

1,375

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“…There are currently 2 publications that we are aware of that have reviewed the current treatments available to prevent cerebral vasospasm in SAH and that mention the potential role for statin therapy. The first review by Naval and colleagues 21 on the different proposed methods of cerebral protection after SAH summarized the current evidence from randomized, controlled trials and retrospective studies that have been conducted on the potential for statins in this role. The second review by Weyer and colleagues 22 was a meta-analytic review of the different treatments that are currently considered for the management of vasospasm after aneurysmal SAH.…”

Section: Sillberg Et Al Do Statins Improve Outcome After Aneurysmal Sah?mentioning

confidence: 99%

Do Statins Improve Outcomes and Reduce the Incidence of Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Sillberg

Wells

Perry

2008

Stroke

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Background and Purpose-Subarachnoid hemorrhage (SAH) is a relatively rare cause of stroke with a high rate of morbidity and mortality, primarily due to the occurrence of delayed vasospasm. To date, many therapies have been proposed to help prevent vasospasm, but very few have been proven effective. The initiation of statin therapy after SAH may be effective in reducing the incidence of vasospasm; however, the only studies that have examined this effect have been small. This meta-analysis attempted to determine whether statins reduce morbidity and mortality after aneurysmal SAH. Methods-MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for randomized, controlled trials relating to the use of statins in SAH. Foreign language and abstract articles were included. Two independent reviewers assessed studies for eligibility, data extraction, and quality. Primary outcome was the incidence of radiographically confirmed clinical vasospasm; secondary outcomes were incidence of delayed ischemic deficits and mortality. Results-The incidence of vasospasm (relative risk [RR]ϭ0.73; 95% CI, 0.54 to 0.99), delayed ischemic deficits (RRϭ0.38; 95% CI, 0.17 to 0.83), and mortality (RRϭ0.22; 95% CI, 0.06 to 0.82) were significantly reduced in the statin group. For these outcomes, we calculated a number needed to treat of 6.25, 5, and 6.7, respectively. Conclusions-Initiation of statin therapy after aneurysmal SAH significantly reduces the incidence of vasospasm, delayed ischemic deficits, and mortality. This is consistent with animal research and retrospective studies and supports the routine use of statins in the care of patients with aneurysmal SAH.

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Section: Abstract • Vasospasmmentioning

confidence: 99%

“…Vasospasm can be demonstrated using angiography in approximately 60 to 70% of patients with ruptured aneurysms. 29,31,38 Clinical vasospasm resulting in DIND occurs in 20 to 30% of patients within 3 to 14 days after aneurysmal SAH. Given that vasospasm is the most common cause of morbidity and mortality in patients who survive the initial bleeding episode, it is imperative not only to diagnose the condition but also to predict which patients are likely to become symptomatic.…”

mentioning

confidence: 99%

“…Early recognition of vasospasm and the potential risk of DIND is essential because the rapid implementation of standard therapies such as triple-H (hypertension, hypervolemia, and hemodilution) therapy, intraarterial vasodilator application, and balloon angioplasty serves to counteract vasospasm and prevent the occurrence of DIND. 24,26,29,38 However, the prompt use of these therapies depends on the ability to predict impending vasospasm or to diagnose it at its early stages.A number of techniques to evaluate cerebral perfusion have been developed during the past several decades, beginning in the 1970s with PET and Xe-CT scanning. During the next two decades, other perfusion imaging techniques were introduced, including SPECT scanning, perfusion-and diffusion-weighted MR imaging, and perfusion CT scanning (Table 1).…”

mentioning

confidence: 99%

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Cerebral perfusion imaging in vasospasm

Lad¹,

Guzman²,

Kelly³

et al. 2006

FOC

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✓Vasospasm following cerebral aneurysm rupture is one of the most devastating sequelae and the most common cause of delayed ischemic neurological deficit (DIND). Because vasospasm also is the most common cause of morbidity and mortality in patients who survive the initial bleeding episode, it is imperative not only to diagnose the condition but also to predict which patients are likely to become symptomatic. The exact pathophysiology of vasospasm is complex and incompletely elucidated. Early recognition of vasospasm is essential because the timely use of several therapeutic interventions can counteract this disease and prevent the occurrence of DIND. However, the prompt implementation of these therapies depends on the ability to predict impending vasospasm or to diagnose it at its early stages. A number of techniques have been developed during the past several decades to evaluate cerebral perfusion, including positron emission tomography, xenon-enhanced computed tomography, single-photon emission computed tomography, perfusion- and diffusion-weighted magnetic resonance imaging, and perfusion computed tomography. In this article, the authors provide a general overview of the currently available perfusion imaging techniques and their applications in treating vasospasm after a patient has suffered a subarachnoid hemorrhage. The use of cerebral perfusion imaging techniques for the early detection of vasospasm is becoming more common and may provide opportunities for early therapeutic intervention to counteract vasospasm in its earliest stages and prevent the occurrence of DINDs.

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Controversies in the management of aneurysmal subarachnoid hemorrhage*

Cited by 82 publications

References 139 publications

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Do Statins Improve Outcomes and Reduce the Incidence of Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Cerebral perfusion imaging in vasospasm

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