title: Ultra-Early Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  After aneurysmal subarachnoid hemorrhage (aSAH), prognosis is affected heavily by the presence of delayed cerebral ischemia (DCI). There is growing recognition of ultra-early angiographic vasospasm (UEAV) occurring within 48 hours of aSAH; however, its relationship with DCI and ultimately prognosis remains unclear.
  
  
  METHODS
  Various databases limited to the English language through September 2016 were searched systematically. Eligible studies were those comparing UEAV with control non-UEAV outcomes and follow-up. Two independent reviewers evaluated the quality of studies and abstracted the data, with discrepancies resolved by a third. We calculated odds ratios (ORs) and 95% confidence intervals for all outcomes by using random-effects meta-analyses and performed a heterogeneity analysis.
  
  
  RESULTS
  Four comparative studies were selected for analysis. Pooled analysis demonstrated that UEAV compared with no-UEAV was associated with greater proportion of rupture aneurysms sized greater than 12 mm (38.3% vs. 24.3%, P < 0.00001). A significantly greater number of patients with UEAV had ruptured MCA aneurysms compared with patients without UEAV (29.7% vs. 19.9%, P = 0.005). Compared with no-UEAV, patients with UEAV were significantly associated with symptomatic cerebral vasospasm (OR 2.07, P = 0.05) and DCI/infarction (OR 2.52, P = 0.02). A significant association also was found between UEAV and an unfavorable outcome at follow-up (OR 1.64, P = 0.03) and greater mortality (OR 2.65, P < 0.00001).
  
  
  CONCLUSIONS
  UEAV was significantly associated with symptomatic cerebral vasospasm, DCI/infarction, unfavorable outcome at follow-up, and greater mortality. Patients with intracerebral hematoma, intraventricular hemorrhage (Fisher Grade IV), larger ruptured aneurysms >12 mm, and an MCA location were more likely to have UEAV.
authors.affiliation: NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Moore
authors.affiliation: Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Xu
authors.affiliation: NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Teng
authors.affiliation: Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Adam A
authors.initials: AA
authors.lastname: Dmytriw
authors.affiliation: Department of Interventional Neuroradiology, Institute of Neurological Sciences, Prince of Wales Hospital and Community Health Services, Prince of Wales Clinical School, University of New South Wales, Randwick, Australia.
authors.forename: Albert H
authors.initials: AH
authors.lastname: Chiu
authors.affiliation: Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
authors.affiliation: Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: athomas6@bidmc.harvard.edu.
authors.forename: Ajith
authors.initials: A
authors.lastname: Thomas
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications / Q000601:surgery; D002545:Brain Ischemia / Q000150:complications*; D002533:Cerebral Angiography / Q000379:methods; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology*
keywords: Cerebral vasospasm; Delayed cerebral ischemia; Meta-analysis; Prognosis; Subarachnoid hemorrhage; Ultra-early angiographic vasospasm