Treatment of cerebral vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis

Boulouis, Grégoire; Labeyrie, Marc Antoine; Raymond, Jean; Rodriguez-Régent, Christine; Lukaszewicz, Anne Claire; Bresson, D.; Hassen, Wagih Ben; Trystram, Denis; Méder, J.F.; Oppenheim, Catherine; Naggara, Olivier

doi:10.1007/s00330-016-4702-y

Cited by 65 publications

(36 citation statements)

References 91 publications

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“…A key difference in the current study design, compared to prior literature, is that we adjusted for confounding factors beyond simply selecting for control patients with normal mental status at hospital admission. It is notable that, in the primary analysis, cases had improved unadjusted outcomes and a trend toward improved adjusted outcomes, a finding that is particularly remarkable given that cases had significantly higher rates of delayed cerebral vasospasm, a complication of aSAH typically associated with significantly worse neurologic outcomes . This observation might indicate the presence of protective factors among patients who initially present with “sentinel” or clinically unimpressive symptoms that are not reflected in the typical predictors of outcome following aSAH, perhaps because those aneurysms are more prone to manifest with minor and/or intermittent leakage as opposed to overt rupture.…”

Section: Discussionmentioning

confidence: 96%

Outcomes Following Possible Undiagnosed Aneurysmal Subarachnoid Hemorrhage: A Contemporary Analysis

Mark

Kene

Vinson

et al. 2017

Academic Emergency Medicine

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In a contemporary cohort of patients with aSAH, we observed no statistically significant increase in the adjusted odds of death or unfavorable neurologic outcomes among patients with clinical evaluations for possible aSAH-related symptoms in the 14 days preceding formal diagnosis of aSAH. While these findings cannot exclude a smaller risk difference than previously reported, they can help refine decision analyses and testing threshold determinations for patients with possible aSAH.

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Section: Discussionmentioning

confidence: 96%

Outcomes Following Possible Undiagnosed Aneurysmal Subarachnoid Hemorrhage: A Contemporary Analysis

Mark

Kene

Vinson

et al. 2017

Academic Emergency Medicine

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“…Endovascular intervention is commonly used to chemically (intra-arterial (IA) infusion of vasodilatory agents) or mechanically (balloon angioplasty) ameliorate vasospasm which has been refractory to medical therapy 7. However, since no randomized controlled trial has evaluated the safety and efficacy of endovascular treatment for vasospasm, the current guidelines are based on clinical case series and expert consensus 8. As such, the clinical effect of endovascular vasospasm treatment remains incompletely understood.…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment for cerebral vasospasm following aneurysmal subarachnoid hemorrhage: predictors of outcome and retreatment

Sokolowski

Chen

Ding

et al. 2017

J NeuroIntervent Surg

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“…25 In a systematic review and meta-analysis of 62 studies (26 of them were randomized trials), Boulouis et al concluded that IAT may improve the outcome after severe/refractory vasospasm. 26 They demonstrated overall an unfavorable outcome after sCVS following aneurysmal SAH in 2,490 of 8,976 patients (33.7%), defined as mRS 3 to 6 at last followup. In our study there was an unfavorable outcome after 6 months in 46.1% for sSAH patients with a single IAT and in 40.8% for patients with multiple IATs for sCVS, but we defined an unfavorable outcome as mRS 4 to 6.…”

Section: Discussionmentioning

confidence: 93%

Symptomatic Cerebral Vasospasm after Spontaneous Subarachnoid Hemorrhage: Comparison of Single and Multiple Intra-arterial Treatment with Respect to the Functional Outcome

Neumann

Ditz

Schacht

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Objective In cases of spontaneous subarachnoid hemorrhage (sSAH) and symptomatic cerebral vasospasm (sCVS), multiple intra-arterial treatments (IATs) can be potentially useful for the functional outcome, even if the prognosis is initially poor. But the actual influence of the number of IATs has yet to be clarified. We wanted to assess if there are differences in the functional outcome between patients with a singular IAT and multiple IATs for sCVS after sSAH. Methods In a single-center study, 405 consecutive patients with nontraumatic SAH were analyzed retrospectively. A total of 126 developed sCVS, and 86 received IAT (32 singular and 54 multiple, i.e., more than one) with nimodipine with or without percutaneous transluminal angioplasty (PTA). Both groups were compared for demographic data, initial treatment (clipping or endovascular), and initial grading (World Federation of Neurosurgical Societies/Fisher classification, intraventricular hemorrhage, and intracerebral hemorrhage). The modified Rankin Scale (mRS) was used to assess functional outcome at the time of discharge and after 3 and 6 months. The development of CVS-associated infarction was assessed by computed tomography (CT). Categorical variables of the patient groups were analyzed in contingency tables using the Fisher exact test, chi-square test, and the Mann-Whitney U test. Statistical significance was accepted at p < 0.05. Results Patient groups with singular and multiple IATs were comparable concerning demographic data and initial grading. At the end of follow-up after 6 months, both groups showed comparable functional outcomes. A favorable outcome (mRS: 0–3) was observed in 14 of 26 patients (53.9%) with a single IAT and for 29 of 49 patients (59.2%) with multiple IATs. An unfavorable outcome (mRS: 4–6) occurred in 12 of 26 patients (46.1%) with a single IAT and for 20 of 49 patients (40.8%) with multiple IATs (p = 0.420). In the group with a single IAT, 22 of 32 patients (68.8%) developed CVS-associated infarction; 32 of 54 patients (59.3%) showed brain infarcts after multiple IATs (p = 0.259). Conclusion For patients with sCVS after sSAH, multiple IATs (nimodipine with or without additional PTA) can be applied safely because no significant differences in functional outcome were observed compared with a singular IAT. We conclude that patients should be treated repeatedly if vasospasm reoccurs.

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Treatment of cerebral vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis

Cited by 65 publications

References 91 publications

Outcomes Following Possible Undiagnosed Aneurysmal Subarachnoid Hemorrhage: A Contemporary Analysis

Outcomes Following Possible Undiagnosed Aneurysmal Subarachnoid Hemorrhage: A Contemporary Analysis

Endovascular treatment for cerebral vasospasm following aneurysmal subarachnoid hemorrhage: predictors of outcome and retreatment

Symptomatic Cerebral Vasospasm after Spontaneous Subarachnoid Hemorrhage: Comparison of Single and Multiple Intra-arterial Treatment with Respect to the Functional Outcome

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