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

  • Interventional
  • Published:
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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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Fig. 1
Fig. 2

Abbreviations

aSAH:

Aneurysmal subarachnoid haemorrhage

CVS:

Cerebral vasospasm

IA:

Intra-arterial

DCI:

Delayed cerebral ischaemia

GOS:

Glasgow Outcome Scale

GOSE:

GOS extended

RCT:

randomised controlled trial

TBA:

Transluminal balloon angioplasty

TCD:

Transcranial Doppler

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Acknowledgements

The scientific guarantor of this publication is Dr Olivier Naggara.

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

The authors state that this work has not received any funding.

One of the authors has significant statistical expertise.

Institutional Review Board approval was not required because the submitted report is a systematic review and meta-analysis.

Methodology: systematic review and meta-analysis.

Author information

Authors and Affiliations

  1. INSERM U894, CH Sainte-Anne, Department of Neuroradiology, Université Paris-Descartes, 1 rue Cabanis, 75014, Paris, France

    Grégoire Boulouis, Christine Rodriguez-Régent, Anne Claire Lukaszewicz, Wagih Ben Hassen, Denis Trystram, Jean Francois Meder, Catherine Oppenheim & Olivier Naggara

  2. DHU NeuroVasc Paris Sorbonne, Paris, France

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

  3. Neuroradiology, and Neurosurgery, Université Paris Diderot Paris VII, Paris, France

    Marc Antoine Labeyrie & Damien Bresson

  4. Department of Radiology, Centre Hospitalier de l’Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada

    Jean Raymond

Authors
  1. Grégoire Boulouis
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  2. Marc Antoine Labeyrie
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  3. Jean Raymond
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  4. Christine Rodriguez-Régent
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  5. Anne Claire Lukaszewicz
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  6. Damien Bresson
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  7. Wagih Ben Hassen
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  8. Denis Trystram
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  9. Jean Francois Meder
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  10. Catherine Oppenheim
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  11. Olivier Naggara
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Corresponding author

Correspondence to Grégoire Boulouis.

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Boulouis, G., Labeyrie, M.A., Raymond, J. et al. Treatment of cerebral vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis. Eur Radiol 27, 3333–3342 (2017). https://doi.org/10.1007/s00330-016-4702-y

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  • DOI: https://doi.org/10.1007/s00330-016-4702-y

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