Role of Cilostazol in Prevention of Vasospasm After Aneurysmal Subarachnoid Hemorrhage–A Systematic Review, Meta-Analysis, and Trial Sequential Analysis

Bohara, Sandeep; Garg, Kanwaljeet; Rajpal, Preet Mohinder Singh; Kasliwal, Manish K.

doi:10.1016/j.wneu.2021.02.069

Cited by 13 publications

(10 citation statements)

References 25 publications

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“… 38 ) Although this effect remained controversial, the recent meta-analysis demonstrated the possibility to prevent severe angiographic and symptomatic vasospasm, new cerebral infarction, and poor outcomes. 39 ) The results are consistent with those of our study to reduce the incidence of DIND by approximately 50% in patients administered with cilostazol. Based on the Japanese Guidelines for the Management of Stroke 2015 (compatible with the 2017 revision), future large-scale comparative studies are needed to provide evidence-based support for cilostazol as an acceptable method to prevent DIND.…”

Section: Discussionsupporting

confidence: 92%

Comparison of Symptomatic Vasospasm after Surgical Clipping and Endovascular Coiling

Imamura

Tani

Adachi

et al. 2022

Neurol. Med. Chir.(Tokyo)

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Vasospasm, initial neurological damage, rebleeding, and periprocedural complications are associated prognostic factors for clinical outcomes after aneurysmal subarachnoid hemorrhage (SAH). In this study, factors related to delayed ischemic neurological deficit (DIND) are evaluated using data from our institute for the last 18 years. Data from 2001 to 2018 of patients with aneurysmal SAH who underwent surgical clipping (SC) or endovascular coiling (EC) within 7 days of onset were retrospectively analyzed. Cases of mortality within 5 days after treatment were excluded. Multivariate analysis was used to identify the risk factors for DIND. In total, 840 cases of SAH were assessed; among these cases, 384 (45.7%) and 456 (54.3%) were treated with SC and EC, respectively. The frequency of DIND in the EC group was significantly less than that in the SC group (11.8% vs. 17.7%; p = 0.016). In the results of multivariate analysis, internal carotid artery (ICA) aneurysm and hemorrhagic complications were the risk factors for DIND. Cilostazol administration and EC were significant factors for vasospasm prevention after aneurysmal SAH (odds ratio of ICA aneurysm: 1.59, hemorrhagic complications: 1.76, SC: 1.51, and cilostazol administration: 0.51, respectively). Cilostazol administration was also a significant factor in patients who were treated with EC. ICA aneurysm, treatment strategy, hemorrhagic complications, and cilostazol administration were associated with DIND. Oral administration of cilostazol and avoiding hemorrhagic complications were effective in DIND prevention. If both treatments are available for ruptured aneurysms, clinicians should choose EC on the basis of its ability to prevent DIND.

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Section: Discussionsupporting

confidence: 92%

Comparison of Symptomatic Vasospasm after Surgical Clipping and Endovascular Coiling

Imamura

Tani

Adachi

et al. 2022

Neurol. Med. Chir.(Tokyo)

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“…We collected data on the mode of investigation to identify aVSP, whether aVSP was assessed for routinely or only if deemed clinically necessary or, after a screening test determined, it was warranted. For RCTs of interventions designed to reduce the incidence of aVSP, we recorded only the reported incidence of aVSP in the control group for interventions that have been shown to reduce the incidence of aVSP such as clazosentan [ 18 ] and cilostazol [ 19 ]. We recorded the criteria used to identify cases of aVSP in each of the included studies.…”

Section: Methodsmentioning

confidence: 99%

The incidence of cerebral arterial vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis

et al. 2022

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Purpose To describe a pooled estimated incidence of cerebral arterial vasospasm (aVSP) following aneurysmal subarachnoid haemorrhage (aSAH) and to describe sources of variation in the reported incidence. Methods We performed a systematic review and meta-analysis of randomised clinical trials (RCTs) and cohort studies. The primary outcome was the proportion of study participants diagnosed with aVSP. We assessed for heterogeneity based on mode of imaging, indication for imaging, study design and clinical characteristics at a study level. Results We identified 120 studies, including 19,171 participants. More than 40 different criteria were used to diagnose aVSP. The pooled estimate of the proportion of patients diagnosed with aVSP was 0.42 (95% CI 0.39 to 0.46, I2 = 96.5%). There was no evidence that the incidence aVSP was different, nor that heterogeneity was reduced, when the estimate was assessed by study type, imaging modalities, the proportion of participants with high grade CT scores or poor grade clinical scores. The pooled estimate of the proportion of study participants diagnosed with aVSP was higher in studies with routine imaging (0.47, 95% CI 0.43 to 0.52, I2 = 96.5%) compared to those when imaging was performed when indicated (0.30, 95% CI 0.25 to 0.36, I2 = 94.0%, p for between-group difference < 0.0005). Conclusion The incidence of cerebral arterial vasospasm following aSAH varies widely from 9 to 93% of study participants. Heterogeneity in the reported incidence may be due to variation in the criteria used to diagnose aVSP. A standard set of diagnostic criteria is necessary to resolve the role that aVSP plays in delayed neurological deterioration following aSAH. PROSPERO registration CRD42020191895

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“…CCBs show strong evidence of preventing DCI in patients with aSAH [33]. Nimodipine is the only medication approved by the U.S. Food and Drug Administration for ACV [10]. Potential mechanisms of the benefits of nimodipine are a neuroprotective cellular effect and the ability to inhibit platelet function by inhibiting thromboxane B 2 release.…”

Section: Performance Evaluation Using ML Modelingmentioning

confidence: 99%

“…Cilostazol is an inhibitor of phosphodiesterase (PDE) III, which leads to an increase in intracellular cyclic adenosine monophosphate (cAMP) content and acts as an antiplatelet agent, peripheral vasodilatory agent, and neuroprotective agent [9]. The prevalence of ACV and DCI can be decreased in patients with aSAH when they are administered cilostazol [10][11][12]. However, there is still a lack of consensus among the related studies.…”

Section: Introductionmentioning

confidence: 99%

Effect of Cilostazol on Delayed Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage Using Explainable Predictive Modeling

2023

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The studies interpreting DCI, a complication of SAH, and identifying correlations are very limited. This study aimed to investigate the effect of cilostazol on ACV and DCI after coil embolization for ruptured aneurysms (n = 432). A multivariate analysis was performed and explainable artificial intelligence approaches were used to analyze the contribution of cilostazol as a risk factor on the development of ACV and DCI with respect to global and local interpretation. The cilonimo group was significantly lower than the nimo group in ACV (13.5% vs. 29.3; p = 0.003) and DCI (7.9% vs. 20.7%; p = 0.006), respectively. In a multivariate logistic regression, the odds ratio for DCI for the cilonimo group, female sex, and aneurysm size was 0.556 (95% confidence interval (CI), 0.351–0.879; p = 0.012), 3.713 (95% CI, 1.683–8.191; p = 0.001), and 1.106 (95% CI, 1.008–1.214; p = 0.034). The risk of a DCI occurrence was significantly increased with an aneurysm size greater than 10 mm (max 80%). The mean AUC of the XGBoost and logistic regression models was 0.94 ± 0.03 and 0.95 ± 0.04, respectively. Cilostazol treatment combined with nimodipine could decrease the prevalence of ACV (13.5%) and DCI (7.9%) in patients with aSAH.

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Role of Cilostazol in Prevention of Vasospasm After Aneurysmal Subarachnoid Hemorrhage–A Systematic Review, Meta-Analysis, and Trial Sequential Analysis

Cited by 13 publications

References 25 publications

Comparison of Symptomatic Vasospasm after Surgical Clipping and Endovascular Coiling

Comparison of Symptomatic Vasospasm after Surgical Clipping and Endovascular Coiling

The incidence of cerebral arterial vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis

Effect of Cilostazol on Delayed Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage Using Explainable Predictive Modeling

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