Department of Neurosurgery Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
Department of Neurosurgery.
Br J Anaesth. 2016 Jul;117(1):17-40. doi: 10.1093/bja/aew095. Epub 2016 May 8.
: The leading cause of morbidity and mortality after surviving the rupture of an intracranial aneurysm is delayed cerebral ischaemia (DCI). We present an update of recent literature on the current status of prevention and treatment strategies for DCI after aneurysmal subarachnoid haemorrhage. A systematic literature search of three databases (PubMed, ISI Web of Science, and Embase) was performed. Human clinical trials assessing treatment strategies, published in the last 5 yr, were included based on full-text analysis. Study data were extracted using tables depicting study type, sample size, and outcome variables. We identified 49 studies meeting our inclusion criteria. Clazosentan, magnesium, and simvastatin have been tested in large high-quality trials but failed to show a beneficial effect. Cilostazol, eicosapentaenoic acid, erythropoietin, heparin, and methylprednisolone yield promising results in smaller, non-randomized or retrospective studies and warrant further investigation. Topical application of nicardipine via implants after clipping has been shown to reduce clinical and angiographic vasospasm. Methods to improve subarachnoid blood clearance have been established, but their effect on outcome remains unclear. Haemodynamic management of DCI is evolving towards euvolaemic hypertension. Endovascular rescue therapies, such as percutaneous transluminal balloon angioplasty and intra-arterial spasmolysis, are able to resolve angiographic vasospasm, but their effect on outcome needs to be proved. Many novel therapies for preventing and treating DCI after aneurysmal subarachnoid haemorrhage have been assessed, with variable results. Limitations of the study designs often preclude definite statements. Current evidence does not support prophylactic use of clazosentan, magnesium, or simvastatin. Many strategies remain to be tested in larger randomized controlled trials.
This systematic review was registered in the international prospective register of systematic reviews.
CRD42015019817.
颅内动脉瘤破裂后导致发病率和死亡率的主要原因是迟发性脑缺血（DCI）。我们对近期关于蛛网膜下腔出血后 DCI 的预防和治疗策略的文献进行了更新。对三个数据库（PubMed、ISI Web of Science 和 Embase）进行了系统的文献检索。根据全文分析，纳入了评估治疗策略的人类临床试验，这些研究均在过去 5 年内发表。使用描述研究类型、样本量和结果变量的表格提取研究数据。我们确定了符合纳入标准的 49 项研究。克拉生坦、镁和辛伐他汀已在大型高质量试验中进行了测试，但未能显示出有益的效果。西洛他唑、二十碳五烯酸、促红细胞生成素、肝素和甲基强的松龙在较小的、非随机或回顾性研究中产生了有希望的结果，值得进一步研究。夹闭后通过植入物局部应用尼卡地平已被证明可减少临床和血管造影性血管痉挛。已经建立了改善蛛网膜下腔血液清除的方法，但它们对结果的影响仍不清楚。DCI 的血流动力学管理正在向等容高血压发展。经皮腔内血管成形术和动脉内血管痉挛松解术等血管内救援疗法能够解决血管造影性血管痉挛，但需要证明其对结果的影响。许多预防和治疗蛛网膜下腔出血后 DCI 的新疗法已经进行了评估，但结果各不相同。研究设计的局限性常常使人们无法做出明确的结论。目前的证据不支持预防性使用克拉生坦、镁或辛伐他汀。许多策略仍需在更大的随机对照试验中进行测试。
本系统评价已在国际前瞻性系统评价注册库中注册。
CRD42015019817。
