Objective: Previous meta-analyses have not reported pooled estimates of response to the treatment of vasospasm with intra-arterial vasodilators (IADs) in aneurysmal subarachnoid hemorrhage (aSAH). The objective of this meta-analysis was to pool estimates of angiographic & clinical response, good outcome, & mortality rates following treatment of vasospasm with IADs.
Methods: We searched PubMed using MeSH terms for “Subarachnoid Hemorrhage" AND ("Endovascular Procedures" OR "Infusions, Intra-Arterial") AND "Vasodilator Agents". Bibliographies of retrieved articles were also searched. Studies reporting clinical and angiographic response, mortality, and outcome, following IAD treatment of vasospasm in adult humans with aSAH were included. All IADs were allowed. Two authors independently selected studies & abstracted data. Mean weighted probabilities (MWP) were calculated using random effects model.
Results: Inclusion criteria were met by 48 studies (n=1264). Heterogeneity was significant in all syntheses (I2 ≥50%; P< 0.5) and studies were of poor quality. Publication bias was significant for the synthesis of mortality. MWP for immediate angiographic response to IAD treatment was 90% (95% CI 84-95%), post-IAD neurological improvement 59% (95% CI 47-71%), good outcome 56% (95% CI 49-63%), and Mortality rate was 9% (95% CI 6-12%). Subgroup analysis is shown in the table.
Conclusion: IAD treatment leads to a fair angiographic and neurologic response but the impact on outcome is unknown. Studies were of poor quality and bias was significant. Current evidence does not support the use of IADs for the treatment of cerebral vasospasm in aSAH. Randomized/pragmatic trials are needed to elucidate the role of IADs in vasospasm in aSAH.