on August 13, 2009
Published online before print August 13, 2009, doi: 10.1161/STROKEAHA.109.560243
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Submitted on June 11, 2009
From the Department of Critical Care Medicine (A.K.), Clinical Neurosciences & Hotchkiss Brain Institute, University of Calgary, Canada; and the Department of Medicine (J.F.), Michigan State University, East Lansing. * To whom correspondence should be addressed. E-mail: andreas.kramer{at}albertahealthservices.ca.
Background and Purpose—Delayed ischemic neurological deficits (DINDs) contribute to poor outcomes after aneurysmal subarachnoid hemorrhage (SAH). Endothelin-1 is an important mediator involved in the development of vasospasm. Methods—We performed a systematic review and meta-analysis of randomized controlled trials assessing the use of endothelin-receptor antagonists (ETRAs) in patients with SAH. Results—Three studies met eligibility criteria, enrolling 867 patients. ETRAs significantly reduced the occurrence of DINDs (OR 0.68 [0.49 to 0.95]) and radiographic vasospasm (OR 0.31 [0.19 to 0.49]), but did not have any impact on mortality (OR 1.09 [0.69 to 1.72]) or poor neurological outcomes (OR 0.87 [0.63 to 1.20]). Any benefit of ETRAs may have been partially offset by adverse effects, including hypotension(OR 2.39 [1.37 to 4.17]) and pulmonary complications (OR 2.12 [1.51 to 2.98]). Conclusions—Although ETRAs reduce radiographic vasospasm and DINDs, there is currently no evidence that they improve outcomes.
Revised on July 3, 2009
Accepted on July 7, 2009
Do Endothelin-Receptor Antagonists Prevent Delayed Neurological Deficits and Poor Outcomes After Aneurysmal Subarachnoid Hemorrhage? A Meta-Analysis
Andreas Kramer MSc, FRCPC, MD* and Jeffrey Fletcher MD
Key words: neurocritial care • SAH • subarachnoid hemorrhage • vasospasm • endothelin
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