Gyanendra Kumar1, Oana M Dumitrascu2, Chia-Chun Chiang3, Cumara B O'Carroll3, Andrei V Alexandrov4. 1. Division of Cerebrovascular Diseases, Department of Neurology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA. kumar.gyanendra@mayo.edu. 2. Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 3. Division of Cerebrovascular Diseases, Department of Neurology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA. 4. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.
Abstract
OBJECT: Cerebral catheter angiography is the gold standard for diagnosing cerebral artery vasospasm (vasospasm) in aneurysmal subarachnoid hemorrhage (SAH). We have previously published a meta-analysis of prediction of delayed cerebral ischemia (DCI) from transcranial Doppler (TCD) evidence of vasospasm. Analogous data relating to prediction of DCI have not been previously collated for cerebral angiography nor reconciled against TCD. METHODS: We searched PUBMED, the Cochrane database, and clinicaltrials.gov for studies that used cerebral angiography for diagnosis of vasospasm and evaluated DCI in patients with SAH. We performed a random-effects meta-analysis of prediction of DCI with cerebral angiography, reconciling its accuracy against that of TCD. We also report quality of evidence for the value of cerebral angiography and TCD in SAH based on pooled data from our meta-analyses. RESULTS: A total of 15 studies (n = 5463) were included in the meta-analysis. Sensitivity (SN), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of cerebral angiography for prediction of DCI are 57, 68, 32, and 90%. These metrics for TCD, based on our previous meta-analysis, are 90, 71, 57, and 92%. We report that test accuracy estimates are "moderate" for TCD and "low" for angiography based on pooled data from our meta-analyses. CONCLUSION: TCD evidence of vasospasm is a better predictor of DCI than angiographic vasospasm. Future comparative effectiveness studies can better define the value of these diagnostic tools in patients with SAH.
OBJECT: Cerebral catheter angiography is the gold standard for diagnosing cerebral artery vasospasm (vasospasm) in aneurysmal subarachnoid hemorrhage (SAH). We have previously published a meta-analysis of prediction of delayed cerebral ischemia (DCI) from transcranial Doppler (TCD) evidence of vasospasm. Analogous data relating to prediction of DCI have not been previously collated for cerebral angiography nor reconciled against TCD. METHODS: We searched PUBMED, the Cochrane database, and clinicaltrials.gov for studies that used cerebral angiography for diagnosis of vasospasm and evaluated DCI in patients with SAH. We performed a random-effects meta-analysis of prediction of DCI with cerebral angiography, reconciling its accuracy against that of TCD. We also report quality of evidence for the value of cerebral angiography and TCD in SAH based on pooled data from our meta-analyses. RESULTS: A total of 15 studies (n = 5463) were included in the meta-analysis. Sensitivity (SN), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of cerebral angiography for prediction of DCI are 57, 68, 32, and 90%. These metrics for TCD, based on our previous meta-analysis, are 90, 71, 57, and 92%. We report that test accuracy estimates are "moderate" for TCD and "low" for angiography based on pooled data from our meta-analyses. CONCLUSION: TCD evidence of vasospasm is a better predictor of DCI than angiographic vasospasm. Future comparative effectiveness studies can better define the value of these diagnostic tools in patients with SAH.
Authors: Gabriela A Santos; Nils Petersen; Amir A Zamani; Rose Du; Sarah LaRose; Andrew Monk; Farzaneh A Sorond; Can Ozan Tan Journal: Neurology Date: 2016-04-22 Impact factor: 9.910
Authors: Eric J Arias; Sravya Vajapey; Matthew R Reynolds; Michael R Chicoine; Keith M Rich; Ralph G Dacey; Ian G Dorward; Colin P Derdeyn; Christopher J Moran; DeWitte T Cross; Gregory J Zipfel; Rajat Dhar Journal: Stroke Date: 2015-09-24 Impact factor: 7.914
Authors: C M Burch; M A Wozniak; M A Sloan; M I Rothman; D Rigamonti; T Permutt; Y Numaguchi Journal: J Neuroimaging Date: 1996-01 Impact factor: 2.486
Authors: Stefan Weidauer; Heinrich Lanfermann; Andreas Raabe; Friedhelm Zanella; Volker Seifert; Jürgen Beck Journal: Stroke Date: 2007-04-19 Impact factor: 7.914
Authors: Amir R Dehdashti; Bernadette Mermillod; Daniel A Rufenacht; Alain Reverdin; Nicolas de Tribolet Journal: Cerebrovasc Dis Date: 2003-10-03 Impact factor: 2.762