■脑血管痉挛(CV)是动脉瘤性蛛网膜下腔出血(aSAH)的常见并发症,导致发病率和死亡率上升。血管内治疗,特别是动脉内血管扩张剂输注(IAVI),已成为CV的潜在替代疗法。
■进行了系统评价和荟萃分析,以比较血管内治疗与标准治疗对aSAH后CV患者的疗效。评估的主要结果是住院死亡率,出院有利的结果,以及后续有利的结果。次要结果包括CT上的严重梗死,ICU住院时间,和总住院时间。
■关于我们感兴趣的主要结果,与标准治疗组相比,接受干预的患者的院内死亡率显着降低,干预组仅有一半的死亡风险(RR=0.49,95%CI[0.29,0.83],p=0.008)。然而,两组在出院结局方面无显著差异(RR=0.99,95%CI[0.68,1.45],p=0.963)和随访有利结果(RR=1.09,95%CI[0.86,1.39],p=0.485)。此外,主要梗死发生率无显著差异(RR=0.79,95%CI[0.34,1.84],p=0.588)。值得注意的是,接受血管内治疗的患者在ICU中的停留时间较长(MD=6.07,95%CI[1.03,11.12],p=0.018)和延长住院时间(MD=5.6,95%CI[3.63,7.56],p<0.001)。基于血管内治疗模式的亚组分析进一步支持IAVI在降低住院死亡率方面的益处(RR=0.5,95%CI[0.27,0.91],p=0.023)。
■血管内治疗,特别是IAVI,在降低aSAH后CV患者的院内死亡率方面具有良好的潜力。然而,在长期预后和功能恢复方面未显示显著改善.需要进一步研究更大的样本量和随机对照试验来验证这些发现并优化aSAH患者脑血管痉挛的治疗策略。
■https://www.crd.约克。AC.英国/PROSPERO/,标识符:CRD42023451741。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: Endovascular therapy, particularly IAVI, holds promising potential in reducing in-hospital 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 treatment strategy for cerebral vasospasm in aSAH patients.
UNASSIGNED: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42023451741.