REVIEW  NEUROSURGICAL SYSTEMATIC REVIEWS AND META-ANALYSES FOR A DAILY PRACTICE - PART III 

Journal of Neurosurgical Sciences 2023 February;67(1):1-9

DOI: 10.23736/S0390-5616.22.05445-5

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

An update of predictors of cerebral infarction after aneurysmal subarachnoid hemorrhage: systematic review and meta-analysis

William A. FLOREZ ^{1, 2}, Rafael MARTINEZ-PEREZ ^{3, 4}, Harsh DEORA ⁵, Andrei F. JOAQUIM ⁶, Ezequiel GARCÍA-BALLESTAS ^{1, 7}, Gabriel A. QUIÑONES-OSSA ^{1, 8} ✉, Claudio RIVAS-PALACIOS ⁷, Amit AGRAWAL ⁹, Sergio A. SERRATO ², Pascal JABBOUR ¹⁰, Luis R. MOSCOTE-SALAZAR ^{1, 2}

¹ Consejo Latinoamericano de Neurointensivismo- CLaNi, Cartagena, Colombia; ² Faculty of Medicine, Universidad Surcolombiana, Neiva, Colombia; ³ Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA; ⁴ Division of Neurosurgery, Institute of Neurosciences, Austral University of Chile, Valdivia, Chile; ⁵ Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India; ⁶ Department of Neurosurgery. University of Campinas (UNICAMP), São Paulo, Brazil; ⁷ Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia; ⁸ Faculty of Medicine, El Bosque University, Bogotá, Colombia; ⁹ Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India; ¹⁰ Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA

INTRODUCTION: Evidence about predictors of poor outcomes such as cerebral infarction (CI) after aneurysmal subarachnoid hemorrhage (aSAH) has not been fully elucidated.
EVIDENCE ACQUISITION: We performed a systematic review and meta-analysis on studies with adults with aSAH considering RCT and non-RCT, prospective, and retrospective cohort studies describing clinical, imaging as well as angiographic studies in patients with aSAH.
EVIDENCE SYNTHESIS: After reviewing the complete text, 11 studies were considered eligible, out of which four were ruled out. Degree of clinical severity was the most predictive factor with a higher degree at the presentation on different severity scales being associated with a statistically significant increasing the risk of suffering a CI following aSAH (OR 2.49 [95% CI 1.38-4.49] P=0.0003). Aneurysm size increased the risk of CI (OR 1.49 [95% CI 1.20-1.85] P=0.0003; I²=4%). In six studies analyzed, it was found that an important factor for the subsequent development of CI is vasospasm (OR 7.62 [2.19, 26.54], P=0.0001).
CONCLUSIONS: The development of vasospasm is a risk factor for CI development after aSAH. In our review, three factors were associated with an increased risk of CI: clinical severity at presentation, vasospasm, and aneurysm size. The major limitation of this meta-analysis is that included studies were conducted retrospectively or were post hoc analyses of a prospective trial.

KEY WORDS: Subarachnoid hemorrhage; Cerebral infarction; Intracranial aneurysm; Intracranial hemorrhage; Brain ischemia