AUTHOR=Ma Yu-Hu , Shang Rui , Li Si-Hao , Wang Ting , Lin Sen , Zhang Chang-Wei 

TITLE=Efficacy of endovascular therapy for cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1360511

DOI=10.3389/fneur.2024.1360511

ISSN=1664-2295

ABSTRACT=Background: Cerebral vasospasm (CV) is a common complication of aneurysmal subarachnoid hemorrhage (aSAH), leading to increased morbidity and mortality rates. Endovascular therapy, particularly intra-arterial vasodilator infusion (IAVI), has emerged as a potential alternative treatment for CV.A systematic review and meta-analysis were conducted to compare the efficacy of endovascular therapy with standard treatment in patients with CV following aSAH. The primary outcomes assessed were in-hospital mortality, discharge favorable outcome, and follow-up favorable outcome. Secondary outcomes included major infarction on CT, ICU stay duration, and total hospital stay.Results: Regarding our primary outcomes of interest, patients undergoing intervention exhibited a significantly lower in-hospital mortality compared to the standard treatment group, with the intervention group having only half the mortality risk (RR=0.49, 95% CI [0.29, 0.83], p=0.008).However, there were no significant differences between the two groups in terms of discharge favorable outcome (RR=0.99, 95% CI [0.68, 1.45], p=0.963) and follow-up favorable outcome (RR=1.09, 95% CI [0.86, 1.39], p=0.485). Additionally, there was no significant difference in major infarction rates (RR=0.79, 95% CI [0.34, 1.84], p=0.588). It is important to note that patients undergoing endovascular treatment experienced longer stays in the ICU (MD=6.07, 95% CI [1.03,    11.12], p=0.018) and extended hospitalization (MD=5.6, 95% CI [3.63, 7.56], p<0.001). Subgroup analyses based on the mode of endovascular treatment further supported the benefits of IAVI in lowering in-hospital mortality (RR=0.5, 95% CI [0.27, 0.91], p=0.023).Endovascular therapy, particularly IAVI, holds promising potential in reducing inhospital mortality for patients with CV following aSAH. However, it did not show significant improvement in long-term prognosis and functional recovery. Further research with larger sample sizes and randomized controlled trials is necessary to validate these findings and optimize the 2 treatment strategy for cerebral vasospasm in aSAH patients.