Prophylactic Therapies for Morbidity and Mortality After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Network Meta-Analysis of Randomized Trials

Dayyani, Mojtaba; Sadeghirad, Behnam; Grotta, James C.; Zabihyan, Samira; Ahmadvand, Saba; Wang, Yuting; Guyatt, Gordon; Amin‐Hanjani, Sepideh

doi:10.1161/strokeaha.121.035699

Cited by 32 publications

(29 citation statements)

References 102 publications

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“…Cerebral vasospasm and delayed cerebral ischemia (DCI) are major factors for survival and functional outcome following SAH and have, for many years, been the main focus in SAH research [ 42 , 43 , 44 , 45 ]. Clinical parameters such as Hunt and Hess scores, lower modified Fisher grade, the absence of intracerebral hematoma, intact pupillary light reflexes, and clinical improvement before aneurysm treatment can be used as early clinical predictors of functional outcome and favorable/non-favorable prognosis [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Inflammatory Markers as Predictors of Shunt Dependency and Functional Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage

et al. 2023

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The mechanisms underlying post-hemorrhagic hydrocephalus (PHH) development following subarachnoid hemorrhage (SAH) are not fully understood, which complicates informed clinical decisions regarding the duration of external ventricular drain (EVD) treatment and prevents the prediction of shunt-dependency in the individual patient. The aim of this study was to identify potential inflammatory cerebrospinal fluid (CSF) biomarkers of PHH and, thus, shunt-dependency and functional outcome in patients with SAH. This study was a prospective observational study designed to evaluate inflammatory markers in ventricular CSF. In total, 31 Patients with SAH who required an EVD between June 2019 and September 2021 at the Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark, were included. CSF samples were collected twice from each patient and analyzed for 92 inflammatory markers via proximity extension assay (PEA), and the prognostic ability of the markers was investigated. In total, 12 patients developed PHH, while 19 were weaned from their EVD. Their 6-month functional outcome was determined with the modified Rankin Scale. Of the 92 analyzed inflammatory biomarkers, 79 were identified in the samples. Seven markers (SCF, OPG, LAP TGFβ1, Flt3L, FGF19, CST5, and CSF1) were found to be predictors of shunt dependency, and four markers (TNFα, CXCL5, CCL20, and IL8) were found to be predictors of functional outcome. In this study, we identified promising inflammatory biomarkers that are able to predict (i) the functional outcome in patients with SAH and (ii) the development of PHH and, thus, the shunt dependency of the individual patients. These inflammatory markers may have the potential to be employed as predictive biomarkers of shunt dependency and functional outcome following SAH and could, as such, be applied in the clinic.

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Section: Discussionmentioning

confidence: 99%

Inflammatory Markers as Predictors of Shunt Dependency and Functional Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage

et al. 2023

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“…Subarachnoid hemorrhage is a serious disease with high morbidity and mortality. This disease affects about 30,000 to 40,000 people in the United States and 60,000 people in the world (12)(13)(14). Patients with SAH may suffer from various complications, such as systemic inflammation, myocardial damage, or cardiac dysfunction (15,16).…”

Section: Introductionmentioning

confidence: 99%

“…More than 30% of patients with SAH die within the first days to the first weeks after SAH. Also, if these patients survive, most of them suffer from cognitive disorders or disability (14,21). This disease has significant complications and mortality, and knowing the prognostic predictors and investigating related factors are of special importance.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Subarachnoid Hemorrhage in Traumatic Brain Injury Patients: A Cross-Sectional Study

et al. 2023

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Background: One of the clinical manifestations and complications of traumatic brain injury patients is traumatic intracranial hemorrhages, divided into primary and secondary hemorrhages. Objectives: The present study was conducted to determine the prevalence of subarachnoid hemorrhage (SAH) in traumatic brain injury (TBI) patients. Methods: The present cross-sectional study was conducted on all TBI patients with SAH for one year. Data collection tools include a demographic profile form and a researcher-made checklist. The severity of TBI is divided according to the Glasgow Coma Scale (GCS) score. The patient’s history and clinical examinations were considered when admitting to the hospital. The consciousness level was measured at 6-to-24-hour intervals, a computed tomography (CT) scan was performed, and any abnormal SAH-related clinical findings and symptoms were recorded. If the patient had other hemorrhages besides SAH, the hematoma volume was recorded. The collected data were entered into and analyzed by SPSS version 16 software. Results: A total of 534 patients were investigated, of whom 84 (15.3%) had intracranial hemorrhage. Out of 84 patients with intracranial hemorrhage, 12 (2.2%) had SAH, of whom ten were male and 2 were female. Also, SAH occurred to traffic accidents, falls, and other related reasons in 7 (58.3%), 4 (33.3%), and 1 (8.3%) patients, respectively. It was also shown that 1 (8.3%), 2 (16.6%), and 9 (75%) patients with SAH had mild, moderate, and severe consciousness, respectively. Regarding the frequency of SAH-related diseases, it was shown that 2 (16.6%) and 10 (82.3%) patients were diabetic and non-diabetic, 4 (33.3%) and 8(66.6%) patients were hypertensive and non-hypertensive, and 7 (58.3%) and 5 (41.6%) patients were with and without a history of skull fractures, respectively, 12 (100%) of them had a history of coagulation disorders. Conclusions: The prevalence of intracranial hemorrhage and SAH in TBI patients is significantly high, which should be taken into consideration when performing diagnostic and therapeutic procedures for these patients.

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“…Clinical trials designed to treat CAV using mechanical or pharmacological vasodilation have failed to show an improvement in clinical outcome,5 6 and, at this time, oral nimodipine is the only class I and level of evidence A medication that has been shown to be an effective preventative treatment for DCI 7. A recent network metanalysis concluded that nimodipine and cilostazol are likely the most effective treatments in preventing morbidity and mortality in patients with aSAH 8. Interestingly, nimodipine does not reduce CAV, which suggests that this drug more likely inhibits cortical spreading ischemia and has fibrinolytic activity that reduces microthrombi 4 9.…”

Section: Introductionmentioning

confidence: 99%

Cervical sympathectomy to treat cerebral vasospasm: a scoping review

Bombardieri

Heifets

Treggiari

et al. 2022

Reg Anesth Pain Med

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Background/ImportanceDelayed cerebral ischemia (DCI) is the second-leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage (aSAH), and is associated with cerebral arterial vasospasm (CAV). Current treatments for CAV are expensive, invasive, and have limited efficacy. Cervical sympathetic block (CSB) is an underappreciated, but potentially highly effective therapy for CAV.ObjectiveTo provide a comprehensive review of the preclinical and human literature pertinent to CSB in the context of CAV.Evidence reviewThis study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We conducted a literature search using Embase, PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science until February 2022, to identify abstracts, conference proceedings, and full-text papers pertinent to cervical sympathectomy and CAV in animal/adult patients.FindingsWe included six human and six experimental studies. Human studies were mostly prospective observational, except one retrospective and one randomized clinical trial, and used various imaging modalities to measure changes in arterial diameter after the block. Studies that used digital subtraction angiography showed an improvement in cerebral perfusion without change in vessel diameter. Transcranial Doppler studies found an approximately 15% statistically significant decrease in velocities consistent with arterial vasodilatation. Overall, the results suggest an increase in cerebral arterial diameter and neurological improvement in patients receiving a CSB. Animal studies demonstrate that sympathetic system ablation vasodilates cerebral vasculature and decreases the incidence of symptomatic vasospasm.ConclusionsThis scoping review suggests that CSB may be a viable option for treatment and prevention of CAV/DCI in patients with aSAH, although the included studies were heterogeneous, mostly observational, and with a small sample size. Further research is needed to standardize the technique and prove its effectiveness to treat patients suffering of CAV/DCI after aSAH.

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Prophylactic Therapies for Morbidity and Mortality After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Network Meta-Analysis of Randomized Trials

Cited by 32 publications

References 102 publications

Inflammatory Markers as Predictors of Shunt Dependency and Functional Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage

Inflammatory Markers as Predictors of Shunt Dependency and Functional Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage

Prevalence of Subarachnoid Hemorrhage in Traumatic Brain Injury Patients: A Cross-Sectional Study

Cervical sympathectomy to treat cerebral vasospasm: a scoping review

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