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21.12.2016 | Interventional

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

verfasst von: Grégoire Boulouis, Marc Antoine Labeyrie, Jean Raymond, Christine Rodriguez-Régent, Anne Claire Lukaszewicz, Damien Bresson, Wagih Ben Hassen, Denis Trystram, Jean Francois Meder, Catherine Oppenheim, Olivier Naggara

Erschienen in: European Radiology | Ausgabe 8/2017

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Abstract

Objectives

To examine the clinical outcome of aneurysmal subarachnoid haemorrhage (aSAH) patients exposed to cerebral vasospasm (CVS)-targeted treatments in a meta-analysis and to evaluate the efficacy of intra-arterial (IA) approaches in patients with severe/refractory vasospasm.

Methods

Randomised controlled trials, prospective and retrospective observational studies reporting clinical outcomes of aSAH patients exposed to CVS targeted treatments, published between 2006-2016 were searched using PubMed, EMBASE and the Cochrane Library. The main endpoint was the proportion of unfavourable outcomes, defined as a modified Rankin score of 3–6 at last follow-up.

Results

Sixty-two studies, including 26 randomised controlled trials, were included (8,976 patients). At last follow-up 2,490 of the 8,976 patients had an unfavourable outcome, including death (random-effect weighted-average, 33.7%; 99% confidence interval [CI], 28.1–39.7%; Q value, 806.0; I ² = 92.7%). The RR of unfavourable outcome was lower in patients treated with Cilostazol (RR = 0.46; 95% CI, 0.25–0.85; P = 0.001; Q value, 1.5; I ² = 0); and in refractory CVS patients treated by IA intervention (RR = 0.68; 95% CI, 0.57–0.80; P < 0.0001; number needed to treat with IA intervention, 6.2; 95% CI, 4.3–11.2) when compared with the best available medical treatment.

Conclusions

Endovascular treatment may improve the outcome of patients with severe-refractory vasospasm. Further studies are needed to confirm this result.

Key Points

• 33.7% of patients with cerebral Vasospasm following aneurysmal subarachnoid-hemorrhage have an unfavorable outcome.

• Refractory vasospasm patients treated using endovascular interventions have lower relative risk of unfavourable outcome.

• Subarachnoid haemorrhage patients with severe vasospasm may benefit from endovascular interventions.

• The relative risk of unfavourable outcome is lower in patients treated with Cilostazol.

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Titel: Treatment of cerebral vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis
verfasst von: Grégoire Boulouis
Marc Antoine Labeyrie
Jean Raymond
Christine Rodriguez-Régent
Anne Claire Lukaszewicz
Damien Bresson
Wagih Ben Hassen
Denis Trystram
Jean Francois Meder
Catherine Oppenheim
Olivier Naggara
Publikationsdatum: 21.12.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 8/2017
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4702-y

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