• World Neurosurg · Nov 2021

    Review Meta Analysis

    Effects of various therapeutic agents on vasospasm and functional outcome following aneurysmal subarachnoid hemorrhage - Results of a network meta-analysis.

    • Sandeep Mishra, Kanwaljeet Garg, Vishwa Bharathi Gaonkar, Preet Mohinder Singh, Manmohan Singh, Ashish Suri, P Sarat Chandra, and Shashank Sharad Kale.
    • Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.
    • World Neurosurg. 2021 Nov 1; 155: 41-53.

    BackgroundVasospasm and delayed ischemic neurologic deficits are the leading causes of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Several therapeutic agents have been assessed in randomized controlled trials for their efficacy in reducing the incidence of vasospasm and improving functional outcome. The aim of this network meta-analysis is to compare all these therapeutic agents for their effect on functional outcome and other parameters after aSAH.MethodsA comprehensive search of different databases was performed to retrieve randomized controlled trials describing the effect of various therapeutic approaches on functional outcome and other parameters after aSAH.ResultsNinety-two articles were selected for full text review and 57 articles were selected for the final analysis. Nicardipine prolonged-release implants were found to be the best treatment in terms of favorable outcome (odds ratio [OR], 8.55; 95% credible interval [CrI], 1.63-56.71), decreasing mortality (OR, 0.08; 95% CrI, 0-0.82), and preventing angiographic vasospasm (OR, 0.018; 95% CrI, 0.00057-0.16). Cilostazol was found to be the second-best treatment in improving favorable outcomes (OR, 3.58; 95% CrI, 1.97-6.57) and decreasing mortality (OR, 0.41; 95% CrI, 0.12-1.15). Fasudil (OR, 0.16; 95% CrI, 0.03-0.78) was found to be the best treatment in decreasing increased vessel velocity and enoxaparin (OR, 0.25; 95% CrI, 0.057-1.0) in preventing delayed ischemic neurologic deficits.ConclusionsOur analysis showed that nicardipine prolonged-release implants and cilostazol were associated with the best chance of improving favorable outcome and mortality in patients with aSAH. However, larger multicentric studies from other parts of the world are required to confirm these findings.Copyright © 2021 Elsevier Inc. All rights reserved.

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