title: Treatment of cerebral vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To examine the clinical outcome of aneurysmal subarachnoid haemorrhage (aSAH) patients exposed to cerebral vasospasm (CVS)-targeted treatments in a meta-analysis and to evaluate the efficacy of intra-arterial (IA) approaches in patients with severe/refractory vasospasm.
  
  
  METHODS
  Randomised controlled trials, prospective and retrospective observational studies reporting clinical outcomes of aSAH patients exposed to CVS targeted treatments, published between 2006-2016 were searched using PubMed, EMBASE and the Cochrane Library. The main endpoint was the proportion of unfavourable outcomes, defined as a modified Rankin score of 3-6 at last follow-up.
  
  
  RESULTS
  Sixty-two studies, including 26 randomised controlled trials, were included (8,976 patients). At last follow-up 2,490 of the 8,976 patients had an unfavourable outcome, including death (random-effect weighted-average, 33.7%; 99% confidence interval [CI], 28.1-39.7%; Q value, 806.0; I2= 92.7%). The RR of unfavourable outcome was lower in patients treated with Cilostazol (RR = 0.46; 95% CI, 0.25-0.85; P = 0.001; Q value, 1.5; I2= 0); and in refractory CVS patients treated by IA intervention (RR = 0.68; 95% CI, 0.57-0.80; P < 0.0001; number needed to treat with IA intervention, 6.2; 95% CI, 4.3-11.2) when compared with the best available medical treatment.
  
  
  CONCLUSIONS
  Endovascular treatment may improve the outcome of patients with severe-refractory vasospasm. Further studies are needed to confirm this result.
  
  
  CONCLUSIONS
  • 33.7% of patients with cerebral Vasospasm following aneurysmal subarachnoid-hemorrhage have an unfavorable outcome. • Refractory vasospasm patients treated using endovascular interventions have lower relative risk of unfavourable outcome. • Subarachnoid haemorrhage patients with severe vasospasm may benefit from endovascular interventions. • The relative risk of unfavourable outcome is lower in patients treated with Cilostazol.
authors.affiliation: INSERM U894, CH Sainte-Anne, Department of Neuroradiology, Université Paris-Descartes, 1 rue Cabanis, 75014, Paris, France. gregoireboulouis@gmail.com.|DHU NeuroVasc Paris Sorbonne, Paris, France. gregoireboulouis@gmail.com.
authors.forename: Grégoire
authors.identifier: http://orcid.org/0000-0001-8422-9205
authors.initials: G
authors.lastname: Boulouis
authors.affiliation: DHU NeuroVasc Paris Sorbonne, Paris, France.|Neuroradiology, and Neurosurgery, Université Paris Diderot Paris VII, Paris, France.
authors.forename: Marc Antoine
authors.initials: MA
authors.lastname: Labeyrie
authors.affiliation: Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Raymond
authors.affiliation: INSERM U894, CH Sainte-Anne, Department of Neuroradiology, Université Paris-Descartes, 1 rue Cabanis, 75014, Paris, France.|DHU NeuroVasc Paris Sorbonne, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Rodriguez-Régent
authors.affiliation: INSERM U894, CH Sainte-Anne, Department of Neuroradiology, Université Paris-Descartes, 1 rue Cabanis, 75014, Paris, France.|DHU NeuroVasc Paris Sorbonne, Paris, France.
authors.forename: Anne Claire
authors.initials: AC
authors.lastname: Lukaszewicz
authors.affiliation: DHU NeuroVasc Paris Sorbonne, Paris, France.|Neuroradiology, and Neurosurgery, Université Paris Diderot Paris VII, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bresson
authors.affiliation: INSERM U894, CH Sainte-Anne, Department of Neuroradiology, Université Paris-Descartes, 1 rue Cabanis, 75014, Paris, France.|DHU NeuroVasc Paris Sorbonne, Paris, France.
authors.forename: Wagih
authors.initials: W
authors.lastname: Ben Hassen
authors.affiliation: INSERM U894, CH Sainte-Anne, Department of Neuroradiology, Université Paris-Descartes, 1 rue Cabanis, 75014, Paris, France.|DHU NeuroVasc Paris Sorbonne, Paris, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Trystram
authors.affiliation: INSERM U894, CH Sainte-Anne, Department of Neuroradiology, Université Paris-Descartes, 1 rue Cabanis, 75014, Paris, France.|DHU NeuroVasc Paris Sorbonne, Paris, France.
authors.forename: Jean Francois
authors.initials: JF
authors.lastname: Meder
authors.affiliation: INSERM U894, CH Sainte-Anne, Department of Neuroradiology, Université Paris-Descartes, 1 rue Cabanis, 75014, Paris, France.|DHU NeuroVasc Paris Sorbonne, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Oppenheim
authors.affiliation: INSERM U894, CH Sainte-Anne, Department of Neuroradiology, Université Paris-Descartes, 1 rue Cabanis, 75014, Paris, France.|DHU NeuroVasc Paris Sorbonne, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Naggara
mesh_terms: D000077407:Cilostazol; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013777:Tetrazoles / Q000627:therapeutic use; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000628:therapy*
chemical_list: D013777:Tetrazoles; D014665:Vasodilator Agents; D000077407:Cilostazol
keywords: Cerebral vasospasm; Delayed cerebral ischaemia; Endovascular treatment; Meta-analysis; Subarachnoid haemorrhage