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

Abstract

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

Early and recurrent cerebral vasospasms after aneurysmal subarachnoid hemorrhage: The impact of age

“…Previous studies have reported an incidence of cerebral vasospasms between 9% and 93%. 1 The broad range of reported incidences might be due to the non-uniform definition of cerebral vasospasms. Most studies used CTA, DSA or elevated flow profiles in TCD to confirm cerebral vasospasms.…”

“…In this single-center, retrospective study we included all patients who were treated at our tertiary stroke center with aSAH in the time between January 2016 and December 2022. Inclusion criteria were as follows: (1) acute SAH due to a ruptured intracranial aneurysm and (2) age >18 years. Exclusion criteria were (1) SAH due to other causes or without evidence of ruptured aneurysm, (2) death within 14 days after symptom onset without the evidence of relevant vasospasms or vasospasm-related infarction, and (3) missing data.…”

“…The incidence of cerebral vasospasms after aneurysmal SAH (aSAH) is highly variable, ranging from 9% to 93%. 1 Despite advances in aneurysm management, cerebral vasospasms remain a strong predictor of poor outcome, attracting research interest over the years. 2 Although the understanding of the pathophysiology of delayed cerebral ischemia (DCI) has expanded beyond Early and recurrent cerebral vasospasms after aneurysmal subarachnoid hemorrhage: The impact of age cerebral vasospasms, 3 a correlation between them remains evident.…”

“…However, identifying patients who are most at risk on any given day is important for focused screening and timely intervention. This retrospective analysis aimed (1) to describe the time course of relevant vasospasms after aSAH and (2) to determine individual risk factors for early-onset or protracted relevant vasospasms. We hypothesize that younger age is not only associated with occurrence of relevant vasospasms, but also with early-onset and recurrent vasospasms.…”

“…The incidence of cerebral vasospasms after aneurysmal SAH (aSAH) is highly variable, ranging from 9% to 93%. 1 Despite advances in aneurysm management, cerebral vasospasms remain a strong predictor of poor outcome, attracting research interest over the years. 2 …”