Delayed cerebral ischemia and vasospasm after spontaneous angiogram-negative subarachnoid hemorrhage: An updated meta-analysis.

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Delayed cerebral ischemia and vasospasm after spontaneous angiogram-negative subarachnoid hemorrhage: An updated meta-analysis.

World Neurosurg. 2018 Apr 21;:

Authors: Lee SU, Hong EP, Kim BJ, Kim SE, Jeon JP

Abstract
OBJECT: To provide an update on the clinical outcomes such as delayed cerebral ischemia (DCI) and vasospasm in angiogram-negative subarachnoid hemorrhage (SAH), according to hemorrhage patterns, perimesencephalic SAH (PMH) and non-PMH.
METHODS: Online databases from January 1990 to December 2017 were systematically reviewed. A fixed-effect model was used to control heterogeneity. To resolve publication bias, the trim and fill method was used to estimate the number of missing studies and adjusted odds ratio (OR). Subgroup analysis of data from studies, which defined angiogram-negative SAH by repeated angiography at least twice or CT angiography, was further performed.
RESULTS: Among 24 studies including 2083 patients, 23/985 (2.3%) PMH and 144/1098 (13.1%) non-PMH showed DCI, indicating that PMH patients experienced significantly lower DCI than non-PMH patients (OR, 0.219; 95% CI: 0.144-0.334). Regarding vasospasm, 99/773 (12.8%) PMH and 231/922 (25.1%) non-PMH patients exhibited vasospasm indicating that PMH patients presented with significantly lower vasospasm than non-PMH patients (OR, 0.445; 95% CI: 0.337-0.589). Funnel plots show asymmetry indicating possible publication bias. After trimming 10 studies for DCI and 7 for vasospasm, the adjusted ORs remained significant between PMH and lower risks of DCI and vasospasm. Subgroup analysis of 789 patients in 8 studies showed a lower risk of DCI (OR, 0.268; 95% CI: 0.151-0.473) and vasospasm (OR, 0.346; 95% CI: 0.221-0.538) in PMH than in non-PMH patients.
CONCLUSIONS: PMH showed a significantly lower risk of DCI and vasospasm than non-PMH. Clinical outcomes of angiogram-negative SAH, based on a meta-analysis of individual patient data, are needed.

PMID: 29689403 [PubMed - as supplied by publisher]

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