Effects of cilostazol treatment for patients with aneurysmal subarachnoid hemorrhage: A meta-analysis of 14 studies

Li, Lian; Fu, Xiouhua; Qiu, Huiming; Shi, Ping‐Ping

doi:10.1016/j.jocn.2021.12.025

Cited by 3 publications

(3 citation statements)

References 41 publications

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“…Cilostazol is the most potent vasodilator among antiplatelet agents and is increasingly considered effective against cerebral vasospasm (13,(16)(17)(18)(19)(20)(21)(22)(23)(24). The preventive effect of cilostazol on cerebral vasospasm has been demonstrated in several RCTs (16,18,20), systematic review and meta-analysis articles (19,(21)(22)(23)(24). In addition, we found that multidrug combination with cilostazol, fasudil, and statin was the most effective in reducing DCI-related cerebral vasospasm.…”

Section: Discussionmentioning

confidence: 78%

“…In Japan, many hospitals use multiple prophylactic drugs, especially cilostazol, which has recently become more common. Cilostazol is the most potent vasodilator among antiplatelet agents and is increasingly considered effective against cerebral vasospasm (13,(16)(17)(18)(19)(20)(21)(22)(23)(24). The preventive effect of cilostazol on cerebral vasospasm has been demonstrated in several RCTs (16,18,20), systematic review and meta-analysis articles (19,(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, only the Hokkaido region responded that microsurgical clipping had a lower incidence of DCI rather than coil embolization, but some clipping-first hospitals in the Hokkaido region routinely asserted that the microsurgical removal of as much subarachnoid hematoma as possible in SAH helps to prevent cerebral vasospasm (25,26). However, previous systematic review and meta-analysis reports support the view that microsurgical manipulation accelerates cerebral vasospasm after SAH (16,19,(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

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Japanese nationwide questionnaire survey on delayed cerebral infarction due to vasospasm after subarachnoid hemorrhage

Nishikawa,

Yamada,

Uchida

et al. 2023

Front. Neurol.

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Background and purposeVarious prophylactic drugs for cerebral vasospasm and delayed cerebral infarction (DCI) after subarachnoid hemorrhage (SAH) have been used in Japan. To investigate the treatment trends for cerebral vasospasm and frequency of DCI after SAH throughout Japan in 2021.MethodsIn 2021 we conducted an anonymous questionnaire survey on management for preventing cerebral vasospasm after aneurysmal SAH, and the frequency of DCI. The questionnaire was emailed to 955 certified neurosurgeons at 553 hospitals in Japan. Of them, 162 hospitals (29% response rate) responded to the questionnaire. Of these, 158 were included in this study, while four hospitals that responded insufficiently were excluded. The efficacy of treatments for reducing DCI were examined through a logistic regression analysis.ResultsAmong 3,093 patients treated with aneurysmal SAH, 281 patients (9.1%) were diagnosed with DCI related to cerebral vasospasm. Coil embolization had significantly lower DCI frequency (6.9%), compared to microsurgical clipping (11.8%, odds ratio, 0.90; 95% confidential intervals, 0.84–0.96; P, 0.007). In addition, cilostazol administration was associated with significantly lower DCI frequency (0.48; 0.27–0.82; 0.026). The efficacy of cilostazol in reducing DCI remained unchanged after adjustment for covariates. The most effective combination of multiple prophylactic drugs in reducing DCI related to cerebral vasospasm was cilostazol, fasudil, and statin (0.38; 0.22–0.67; 0.005).ConclusionsThis study elucidated the trends in prophylactic drugs to prevent cerebral vasospasm and frequency of DCI after aneurysmal SAH in Japan. Coil embolization and cilostazol administration showed effectiveness in reducing DCI related to cerebral vasospasm in 2021.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Japanese nationwide questionnaire survey on delayed cerebral infarction due to vasospasm after subarachnoid hemorrhage

Nishikawa,

Yamada,

Uchida

et al. 2023

Front. Neurol.

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Evolving approaches in the management of patients with subarachnoid hemorrhage from 2002 to 2022: The impact of clazosentan and treatment modalities on outcomes

Maeda,

Izumo,

Okamura

et al. 2024

Brain Hemorrhages

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Cilostazol Alleviates Delayed Cerebral Ischemia after Subarachnoid Hemorrhage by Attenuating Microcirculatory Dysfunction

Naraoka,

Shimamura,

Ohkuma

2024

Preprint

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Cilostazol, which exerts its antiplatelet effect by inhibiting anti-PDE3, could have a therapeutic effect on delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). However, the mechanism by which cilostazol alleviates DCI has not been established. We hypothesized that cilostazol alleviates DCI by diminishing cerebral microcirculatory disturbances, a component of Early Brain Injury, by analyzing intracerebral circulation time (iCCT) among patients from two randomized controlled trials. Using data from 256 patients with aSAH, we measured the iCCT was described as the TTP in the ultra-early phase (the baseline iCCT) and the TTP in the subacute phase and/or at the onset of DCI (the follow-up iCCT). In addition, the difference in the iCCT was calculated by subtracting the baseline iCCT from the follow-up iCCT (iCCT differences). In the two RCTs, 74 patients received cilostazol, 54 received pitavastatin, and 128 were controls. We examined the effect of cilostazol and pitavastatin treatment on cerebral microcirculatory disturbances using iCCT as an index. A minority of patients (n = 72; 28%) had severe aVS, DCI (n = 42; 16%), and poor outcomes (n = 35; 14%). The cilostazol arm showed shorter follow-up iCCT and expanded iCCT differences suggesting improved microcirculatory dysfunction among those with DCI and among patients with poor outcomes than those with pitavastatin and control arms. Cilostazol treatment and Hunt & Hess grade 3–4 were associated with poor patient outcomes. Alleviation of DCI and improvements in outcomes among patients with aSAH after cilostazol treatment may be due to diminished microcirculatory dysfunction.

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Effects of cilostazol treatment for patients with aneurysmal subarachnoid hemorrhage: A meta-analysis of 14 studies

Cited by 3 publications

References 41 publications

Japanese nationwide questionnaire survey on delayed cerebral infarction due to vasospasm after subarachnoid hemorrhage

Japanese nationwide questionnaire survey on delayed cerebral infarction due to vasospasm after subarachnoid hemorrhage

Evolving approaches in the management of patients with subarachnoid hemorrhage from 2002 to 2022: The impact of clazosentan and treatment modalities on outcomes

Cilostazol Alleviates Delayed Cerebral Ischemia after Subarachnoid Hemorrhage by Attenuating Microcirculatory Dysfunction

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