Endovascular Treatment of Symptomatic Vasospasm and Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage – a Systematic Review and Meta-analysis
Bibliographic record
Abstract
Abstract Introduction Endovascular rescue treatment, including intra-arterial spasmolysis and/or transluminal balloon angioplasty, is widely used for symptomatic vasospasm and delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), yet its impact on functional recovery remains uncertain. We systematically reviewed and synthesized the evidence on patient-centered outcomes, exploring effects by follow-up time, intervention type, and clinical severity. Materials and methods Following a prospectively registered protocol (Research Registry: reviewregistry1466) and PRISMA guidance, we searched PubMed, EMBASE, and Web of Science (January 2000–December 2024; final update July 2025). Prospective and retrospective studies of adult aSAH patients receiving endovascular treatment for symptomatic angiographic vasospasm were included. Data extraction followed a standardized PICO framework, and study quality was assessed using the Newcastle–Ottawa Scale. Because reporting of angiographic resolution and DCI-related infarction was sparse or inconsistent, quantitative synthesis focused on dichotomized favorable functional outcome (e.g., mRS 0–2 or GOS good recovery). Single-arm meta-analyses of proportions were performed on the logit scale using random-effects generalized linear mixed models, with subgrouping by follow-up, intervention, and clinical severity. Results Thirty-nine studies (1,627 patients; 27 retrospective cohorts, 5 prospective cohorts, 5 case series, 2 randomized trials) met inclusion criteria; 38 contributed to meta-analysis. The pooled proportion of favorable functional outcomes was 0.55 (95% CI, 0.50–0.61) with substantial heterogeneity (I² ≈ 71%). Prespecified subgroup analyses by follow-up duration, intervention type, and baseline severity did not reveal significant differences. The two randomized trials reported conflicting short-term results with limited follow-up. Safety reporting was variable but generally acceptable for pharmacologic spasmolysis, while higher complication rates were occasionally observed with mechanical interventions. Conclusion Among patients with symptomatic vasospasm or DCI requiring endovascular rescue, approximately half achieve a favorable functional outcome. However, marked heterogeneity and reliance on predominantly observational data preclude firm conclusions regarding comparative effectiveness. Standardized multicenter randomized trials with harmonized definitions of eligibility, timing, outcomes, and adverse events are needed to clarify the therapeutic role and optimize patient selection for endovascular rescue after aSAH.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.022 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".