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.
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.
Authors: Bhavani P Thampatty; Paula R Sherwood; Matthew J Gallek; Elizabeth A Crago; Dianxu Ren; Allison J Hricik; Chien-Wen J Kuo; Megan M Klamerus; Sheila A Alexander; Catherine M Bender; Leslie A Hoffman; Michael B Horowitz; Amin B Kassam; Samuel M Poloyac Journal: Neurocrit Care Date: 2011-08 Impact factor: 3.210
Authors: Katsuhito Yasuno; Mehmet Bakırcıoğlu; Siew-Kee Low; Kaya Bilgüvar; Emília Gaál; Ynte M Ruigrok; Mika Niemelä; Akira Hata; Philippe Bijlenga; Hidetoshi Kasuya; Juha E Jääskeläinen; Dietmar Krex; Georg Auburger; Matthias Simon; Boris Krischek; Ali K Ozturk; Shrikant Mane; Gabriel J E Rinkel; Helmuth Steinmetz; Juha Hernesniemi; Karl Schaller; Hitoshi Zembutsu; Ituro Inoue; Aarno Palotie; François Cambien; Yusuke Nakamura; Richard P Lifton; Murat Günel Journal: Proc Natl Acad Sci U S A Date: 2011-11-21 Impact factor: 11.205
Authors: R Loch Macdonald; Randall T Higashida; Emanuela Keller; Stephan A Mayer; Andy Molyneux; Andreas Raabe; Peter Vajkoczy; Isabel Wanke; Aline Frey; Angelina Marr; Sébastien Roux; Neal F Kassell Journal: Neurocrit Care Date: 2010-12 Impact factor: 3.210
Authors: Christian Burrell; Nicole E Avalon; Jason Siegel; Michael Pizzi; Tumpa Dutta; M Cristine Charlesworth; William D Freeman Journal: Expert Rev Neurother Date: 2016-07-11 Impact factor: 4.618