Meta-analysis of timing of endovascular aneurysm treatment in subarachnoid haemorrhage: inconsistent results of early treatment within 1 day

Rawal, Shail; Alcaide‐Leon, Paula; Macdonald, R. Loch; Rinkel, Gabriël J.E.; Victor, J. Charles; Krings, Timo; Kapral, Moira K.; Laupacis, Andreas

doi:10.1136/jnnp-2016-314596

Cited by 36 publications

(41 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The main question is then whether emergent aneurysm repair, akin to management of ischemic stroke with thrombectomy, compares to the more-common approach of repairing the aneurysm within 24 or so hours. It has been challenging, even in retrospective and post hoc analyses, to show any benefit to emergency repair [58]. Oudshoorn and colleagues compared adjusted risks of death and dependency among 1238 patients who had aneurysm repair within 24 h vs. 24 to 72 h of aSAH [59].…”

Section: Aneurysm Repairmentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage: the Last Decade

Neifert

Chapman

Martini

et al. 2020

Transl. Stroke Res.

249

170

View full text Add to dashboard Cite

Aneurysmal subarachnoid hemorrhage (SAH) affects six to nine people per 100,000 per year, has a 35% mortality, and leaves many with lasting disabilities, often related to cognitive dysfunction. Clinical decision rules and more sensitive computed tomography (CT) have made the diagnosis of SAH easier, but physicians must maintain a high index of suspicion. The management of these patients is based on a limited number of randomized clinical trials (RCTs). Early repair of the ruptured aneurysm by endovascular coiling or neurosurgical clipping is essential, and coiling is superior to clipping in cases amenable to both treatments. Aneurysm repair prevents rebleeding, leaving the most important prognostic factors for outcome early brain injury from the hemorrhage, which is reflected in the neurologic condition of the patient, and delayed cerebral ischemia (DCI). Observational studies suggest outcomes are better when patients are managed in specialized neurologic intensive care units with inter-or multidisciplinary clinical groups. Medical management aims to minimize early brain injury, cerebral edema, hydrocephalus, increased intracranial pressure (ICP), and medical complications. Management then focuses on preventing, detecting, and treating DCI. Nimodipine is the only pharmacologic treatment that is approved for SAH in most countries, as no other intervention has demonstrated efficacy. In fact, much of SAH management is derived from studies in other patient populations. Therefore, further study of complications, including DCI and other medical complications, is needed to optimize outcomes for this fragile patient population.

show abstract

Section: Aneurysm Repairmentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage: the Last Decade

Neifert

Chapman

Martini

et al. 2020

Transl. Stroke Res.

249

170

View full text Add to dashboard Cite

show abstract

“…Most of rebleeding events occur in the very early phase after SAH and result in poor functional outcome or death [27]. Although early obliteration of aneurysms might be beneficial, conflicting data exist for best timing of aneurysm treatment [81].…”

Section: Current Implications For Clinical Practicementioning

confidence: 99%

Early Brain Injury After Poor-Grade Subarachnoid Hemorrhage

Rass

Helbok

2019

Curr Neurol Neurosci Rep

174

107

View full text Add to dashboard Cite

Purpose of Review Over the last years, the focus of clinical and animal research in subarachnoid hemorrhage (SAH) shifted towards the early phase after the bleeding based on the association of the early injury pattern (first 72 h) with secondary complications and poor outcome. This phase is commonly referenced as early brain injury (EBI). In this clinical review, we intended to overview commonly used definitions of EBI, underlying mechanisms, and potential treatment implications. Recent Findings We found a large heterogeneity in the definition used for EBI comprising clinical symptoms, neuroimaging parameters, and advanced neuromonitoring techniques. Although specific treatments are currently not available, therapeutic interventions are aimed at ameliorating EBI by improving the energy/supply mismatch in the early phase after SAH. Summary Future research integrating brain-derived biomarkers is warranted to improve our pathophysiologic understanding of EBI in order to ameliorate early injury patterns and improve patients’ outcomes.

show abstract

“…The benefit of ultra-early treatment may be more pronounced for coiling than for surgical clipping 1. However, results have been inconsistent and it remains unclear whether ultra-early endovascular treatment improves clinical outcome in patients with aSAH in comparison with treatment within 24–72 hours 2. In a recent meta-analysis, comparison of the outcome after treatment within 24 hours and between 24 and 72 hours showed no clinical benefit of early treatment 2.…”

Section: Introductionmentioning

confidence: 99%

“…In a recent meta-analysis, comparison of the outcome after treatment within 24 hours and between 24 and 72 hours showed no clinical benefit of early treatment 2. One study suggested that ultra-early treatment exposes patients to harm 2. A potential risk of aneurysm obliteration within the first hours after rupture is a higher chance of perprocedural aneurysm rupture.…”

Section: Introductionmentioning

confidence: 99%