Ultra-Early Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Kevin Phan, Justin M Moore, Christoph J Griessenauer, Joshua Xu, Ian Teng, Adam A Dmytriw, Albert H Chiu, Christopher S Ogilvy, Ajith Thomas

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

OBJECTIVE: After aneurysmal subarachnoid hemorrhage (aSAH), prognosis is affected heavily by the presence of delayed cerebral ischemia (DCI). There is growing recognition of ultra-early angiographic vasospasm (UEAV) occurring within 48 hours of aSAH; however, its relationship with DCI and ultimately prognosis remains unclear.

METHODS: Various databases limited to the English language through September 2016 were searched systematically. Eligible studies were those comparing UEAV with control non-UEAV outcomes and follow-up. Two independent reviewers evaluated the quality of studies and abstracted the data, with discrepancies resolved by a third. We calculated odds ratios (ORs) and 95% confidence intervals for all outcomes by using random-effects meta-analyses and performed a heterogeneity analysis.

RESULTS: Four comparative studies were selected for analysis. Pooled analysis demonstrated that UEAV compared with no-UEAV was associated with greater proportion of rupture aneurysms sized greater than 12 mm (38.3% vs. 24.3%, P < 0.00001). A significantly greater number of patients with UEAV had ruptured MCA aneurysms compared with patients without UEAV (29.7% vs. 19.9%, P = 0.005). Compared with no-UEAV, patients with UEAV were significantly associated with symptomatic cerebral vasospasm (OR 2.07, P = 0.05) and DCI/infarction (OR 2.52, P = 0.02). A significant association also was found between UEAV and an unfavorable outcome at follow-up (OR 1.64, P = 0.03) and greater mortality (OR 2.65, P < 0.00001).

CONCLUSIONS: UEAV was significantly associated with symptomatic cerebral vasospasm, DCI/infarction, unfavorable outcome at follow-up, and greater mortality. Patients with intracerebral hematoma, intraventricular hemorrhage (Fisher Grade IV), larger ruptured aneurysms >12 mm, and an MCA location were more likely to have UEAV.

Original languageEnglish
Pages (from-to)632-638.e1
JournalWorld Neurosurgery
Volume102
DOIs
Publication statusPublished - Jun 2017
Externally publishedYes

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Copyright © 2017 Elsevier Inc. All rights reserved.

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    Phan, K., Moore, J. M., Griessenauer, C. J., Xu, J., Teng, I., Dmytriw, A. A., Chiu, A. H., Ogilvy, C. S., & Thomas, A. (2017). Ultra-Early Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. World Neurosurgery, 102, 632-638.e1. https://doi.org/10.1016/j.wneu.2017.03.057