Evidence map›Paper›PMID 34302553›Full record

ArticleActa neurochirurgica2021

Intensive therapies of delayed cerebral ischemia after subarachnoid hemorrhage: a propensity-matched comparison of different center-driven strategies.

Marc-Antoine Labeyrie, Davide Simonato, Sergios Gargalas, Louis Morisson, Jonathan Cortese, Mario Ganau, Maurizio Fuschi, Jash Patel, Sébastien Froelich, Samuel Gaugain and 2 more

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In one paragraph

Article in Acta neurochirurgica, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 2 pooled it
0.7field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 2 syntheses or guidelines pooled it, 10 citations in OpenAlex.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 3 institutions in 2 countries.

Marc-Antoine LabeyrieInterventional Neuroradiology Unit, Hôpital Lariboisière, Université de Paris, 2 rue Ambroise Paré, 75010, Paris, France. marc-antoine.labeyrie@aphp.fr.
Davide SimonatoInterventional Neuroradiology Unit, John Radcliffe Hospital, Oxford, UK.
Sergios GargalasInterventional Neuroradiology Unit, John Radcliffe Hospital, Oxford, UK.
Louis MorissonIntensive Care Unit, Hôpital Lariboisière, Université de Paris, Paris, France.
Jonathan CorteseInterventional Neuroradiology Unit, Hôpital Lariboisière, Université de Paris, 2 rue Ambroise Paré, 75010, Paris, France.
Mario GanauNeurosurgery Unit, John Radcliffe Hospital, Oxford, UK.
Maurizio FuschiInterventional Neuroradiology Unit, John Radcliffe Hospital, Oxford, UK.
Jash PatelNeurosurgery Unit, John Radcliffe Hospital, Oxford, UK.
Sébastien FroelichNeurosurgery Unit, Hôpital Lariboisière, Université de Paris, Paris, France.
Samuel GaugainIntensive Care Unit, Hôpital Lariboisière, Université de Paris, Paris, France.
Benjamin ChoustermanIntensive Care Unit, Hôpital Lariboisière, Université de Paris, Paris, France.
Emmanuel HoudartInterventional Neuroradiology Unit, Hôpital Lariboisière, Université de Paris, 2 rue Ambroise Paré, 75010, Paris, France.
Hôpital Lariboisière · FRJohn Radcliffe Hospital · GBInserm · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIntensive therapies of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) have still controversial and unproven benefit. We aimed to compare the overall efficacy of two different center-driven strategies for the treatment of DCI respectively with and without vasospasm angioplasty.

methodsTwo hundred consecutive patients with aSAH were enrolled in each of two northern European centers. In an interventional center, vasospasm angioplasty was indicated as first line rather than rescue treatment of DCI using distal percutaneous balloon angioplasty technique combined with intravenous milrinone. In non-interventional center, induced hypertension was the only intensive therapy of DCI. Radiological DCI (new cerebral infarcts not visible on immediate post-treatment imaging), death at 1 month, and favorable outcome at 6 months (modified Rankin scale score ≤ 2) were retrospectively analyzed by independent observers and compared between two centers before and after propensity score (PS) matching for baseline characteristics.

resultsBaseline characteristics only differed between centers for age and rate of smokers and patients with chronic high blood pressure. In the interventional center, vasospasm angioplasty was performed in 38% of patients with median time from bleeding of 8 days (Q1 = 6.5;Q3 = 10). There was no significant difference of incidence of radiological DCI (9% vs.14%, P = 0.11), death (8% vs. 9%, P = 0.4), and favorable outcome 74% vs. 72% (P = 0.4) between interventional and non-interventional centers before and after PS matching.

conclusionsOur results suggest either that there is no benefit, or might be minimal, of one between two different center-driven strategies for intensive treatment of DCI. Despite potential lack of power or unknown confounders in our study, these results question the use of such intensive therapies in daily practice without further optimization and validation.

Indexed as

Brain IschemiaSubarachnoid HemorrhageVasospasm, IntracranialAngioplastyCerebral InfarctionHumansRetrospective StudiesAneurysmal subarachnoid hemorrhageCerebral vasospasmDelayed cerebral ischemiaPercutaneous intraluminal angioplasty

Identifiers

PMID34302553
OpenAlexW3184639374

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.