Abstract TMP105: Endovascular Treatment of Severe and Refractory Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage Improves Outcome: A Systematic Review and Meta-analysis of Different Treatment Options Evaluated Since 2006 for Cerebral Vasospasm

Autor:	Christine Rodriguez-Régent, Anne-Claire Lukaszewicz, Denis Trystram, Jean-François Meder, Wagih Ben Hassen, Gregoire Boulouis, Olivier Naggara, Damien Bresson, Marc-Antoine Labeyrie, Jean Raymond, Catherine Oppenheim
Rok vydání:	2016
Předmět:	Advanced and Specialized Nursing medicine.medical_specialty Subarachnoid hemorrhage business.industry Treatment options medicine.disease Surgery Cerebral vasospasm Refractory Meta-analysis medicine Neurology (clinical) Endovascular treatment Cardiology and Cardiovascular Medicine business
Zdroj:	Stroke. 47
ISSN:	1524-4628 0039-2499
Popis:	Introduction: To report clinical outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients exposed to cerebral vasospasm (CVS) targeted treatments in a systematic review and meta-analysis and compare the efficacy of endovascular and non-endovascular treatments in severe / refractory vasospasm patients. Methods: The literature was searched using PubMed, EMBASE, and The Cochrane Library database. Eligibility criteria were (1) Rated clinical outcome; (2) at least 10 patients; (3) aSAH; (4) study published in English or French (January 2006 - October 2014); and (5) methodological quality score > 10, according to STROBE criteria. Endpoint included unfavorable outcome rate, defined as mRS 3-6, GOS 1-3 or GOSE 1-4 at latest follow-up. Analyses included stratification per route of administration (oral, i.v., intra-arterial or cisternoventricular) and per study inclusion criteria (severe, CVS, refractory CVS or high risk for CVS). Univariate and multivariate subgroup analyses were performed to identify interventions associated with a better outcome. Results: Sixty-two studies, including 26 randomized controlled trials, were included (8976 patients). Overall 2490 patients had unfavorable outcome including death (random-effect weighted average: 33.7%, 99%CI, 28.1-39.7%; Q-value: 806.0, I 2 =92.7%). Clinical outcome was significantly better in severe or refractory patients for whom, on top of best medical treatment, endovascular intervention was performed (RR=0.76, IC95% [0.66-0.89], p 2 = 0). Conclusion: In case of CVS following aSAH, endovascular treatment in severe / refractory vasospasm patients. including intra-arterial injection of pharmacological agents or balloon angioplasty, improves outcome as compared to other route of administration.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::817a6d995f4b3cf3d512a2bcacecc4bb https://doi.org/10.1161/str.47.suppl_1.tmp105 Zobrazit plný text záznamu