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Review Article   

Journal of Neurosurgical Sciences 2022 Sep 16

DOI: 10.23736/S0390-5616.22.05445-5


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 after aneurysmal subarachnoid hemorrhage has not been fully elucidated.
EVIDENCE ACQUISITION: We performed a systematic review and meta-analysis on studies with adults with aneurysmal subarachnoid hemorrhage considering RCT and non-RCT, prospective, and retrospective cohort studies describing clinical, imaging as well as angiographic studies in patients with aneurysmal subarachnoid hemorrhage.
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; Predictor; Intracranial aneurysm; Aneurysm; Intracranial bleeding; Brain ischemia

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