TY - JOUR
T1 - Time trends in the risk of delayed cerebral ischemia after subarachnoid hemorrhage
T2 - a meta-analysis of randomized controlled trials
AU - Rigante, Luigi
AU - van Lieshout, Jasper Hans
AU - Vergouwen, Mervyn D.I.
AU - van Griensven, Carlijn H.S.
AU - Vart, Priya
AU - van der Loo, Lars
AU - de Vries, Joost
AU - Vinke, Ruben Saman
AU - Etminan, Nima
AU - Aquarius, Rene
AU - Gruber, Andreas
AU - Mocco, J.
AU - Welch, Babu G.
AU - Menovsky, Tomas
AU - Klijn, Catharina J.M.
AU - Bartels, Ronald H.M.A.
AU - Germans, Menno R.
AU - Hänggi, Daniel
AU - Boogaarts, Hieronymus D.
N1 - Funding Information:
Dr. de Vries: consultant for Stryker Neurovascular and Evasc Ltd. Dr. Mocco: direct stock ownership in Imperative, Endostream, Synchron, Viseon, Vastrax, Viz.ai, and Q-Apel; and principal investigator of grant funded by MicroVention, Penumbra, and Stryker. Dr. Welch: consultant for Stryker Neurovascular, Medtronic, MicroVention, and Balt; and royalties from Peter Lazic.
Publisher Copyright:
© AANS 2022, except where prohibited by US copyright law
PY - 2022
Y1 - 2022
N2 - OBJECTIVE Delayed cerebral ischemia (DCI) contributes to morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Continuous improvement in the management of these patients, such as neurocritical care and aneurysm repair, may decrease the prevalence of DCI. In this study, the authors aimed to investigate potential time trends in the prevalence of DCI in clinical studies of DCI within the last 20 years. METHODS PubMed, Embase, and the Cochrane library were searched from 2000 to 2020. Randomized controlled trials that reported clinical (and radiological) DCI in patients with aSAH who were randomized to a control group receiving standard care were included. DCI prevalence was estimated by means of random-effects meta-analysis, and subgroup analyses were performed for the DCI sum score, Fisher grade, clinical grade on admission, and aneurysm treatment method. Time trends were evaluated by meta-regression. RESULTS The search strategy yielded 5931 records, of which 58 randomized controlled trials were included. A total of 4424 patients in the control arm were included. The overall prevalence of DCI was 0.29 (95% CI 0.26–0.32). The event rate for prevalence of DCI among the high-quality studies was 0.30 (95% CI 0.25–0.34) and did not decrease over time (0.25% decline per year; 95% CI −2.49% to 1.99%, p = 0.819). DCI prevalence was higher in studies that included only higher clinical or Fisher grades, and in studies that included only clipping as the treatment modality. CONCLUSIONS Overall DCI prevalence in patients with aSAH was 0.29 (95% CI 0.26–0.32) and did not decrease over time in the control groups of the included randomized controlled trials.
AB - OBJECTIVE Delayed cerebral ischemia (DCI) contributes to morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Continuous improvement in the management of these patients, such as neurocritical care and aneurysm repair, may decrease the prevalence of DCI. In this study, the authors aimed to investigate potential time trends in the prevalence of DCI in clinical studies of DCI within the last 20 years. METHODS PubMed, Embase, and the Cochrane library were searched from 2000 to 2020. Randomized controlled trials that reported clinical (and radiological) DCI in patients with aSAH who were randomized to a control group receiving standard care were included. DCI prevalence was estimated by means of random-effects meta-analysis, and subgroup analyses were performed for the DCI sum score, Fisher grade, clinical grade on admission, and aneurysm treatment method. Time trends were evaluated by meta-regression. RESULTS The search strategy yielded 5931 records, of which 58 randomized controlled trials were included. A total of 4424 patients in the control arm were included. The overall prevalence of DCI was 0.29 (95% CI 0.26–0.32). The event rate for prevalence of DCI among the high-quality studies was 0.30 (95% CI 0.25–0.34) and did not decrease over time (0.25% decline per year; 95% CI −2.49% to 1.99%, p = 0.819). DCI prevalence was higher in studies that included only higher clinical or Fisher grades, and in studies that included only clipping as the treatment modality. CONCLUSIONS Overall DCI prevalence in patients with aSAH was 0.29 (95% CI 0.26–0.32) and did not decrease over time in the control groups of the included randomized controlled trials.
KW - Aneurysmal subarachnoid hemorrhage
KW - Cerebral vasospasm
KW - Delayed cerebral ischemia
KW - Delayed ischemic neurologic deficit
KW - Meta-analysis
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U2 - 10.3171/2021.12.FOCUS21473
DO - 10.3171/2021.12.FOCUS21473
M3 - Article
C2 - 35231892
AN - SCOPUS:85125556678
SN - 1092-0684
VL - 52
JO - Neurosurgical focus
JF - Neurosurgical focus
IS - 3
M1 - E2
ER -