Evidence map›Paper›PMID 41148372›Full record

SynthesisNeurosurgical review2025

Efficacy and safety of balloon Angioplasty and Intra-Arterial calcium channel blockers in the management of Cerebral Vasospasm: a systematic review and meta-analysis.

Basel Musmar, Atakan Orscelik, Joanna M Roy, John Victor Malhab El Khoury, Nimer Adeeb, Stavropoula I Tjoumakaris, Michael Reid Gooch, Christina Notarianni, Bharat Guthikonda, Jacques Morcos and 2 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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.

Basel MusmarDepartment of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia, PA, 19107, USA.
Atakan OrscelikDepartment of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
Joanna M RoyDepartment of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia, PA, 19107, USA.
John Victor Malhab El KhourySchool of Medicine, Saint Joseph University, Beirut, Lebanon.
Nimer AdeebDepartment of Radiology and Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Stavropoula I TjoumakarisDepartment of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia, PA, 19107, USA.
Michael Reid GoochDepartment of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia, PA, 19107, USA.
Christina NotarianniDepartment of Radiology and Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Bharat GuthikondaDepartment of Radiology and Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
Jacques MorcosDepartment of Neurosurgery, McGovern Medical School, UT Health Sciences Center at Houston, Houston, TX, USA.
Robert H RosenwasserDepartment of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia, PA, 19107, USA.
Pascal JabbourDepartment of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia, PA, 19107, USA. pascal.jabbour@jefferson.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Cerebral vasospasm is a leading cause of delayed cerebral ischemia following subarachnoid hemorrhage (SAH), often resulting in high morbidity and mortality. While balloon angioplasty (BA) and intra-arterial calcium channel blockers (IA CCBs) are utilized for vasospasm management, their efficacy and safety remain unclear. We systematically searched PubMed, Scopus, and Web of Science for studies reporting on BA or IA CCB treatment for cerebral vasospasm up to October 2024, following PRISMA guidelines. Seventy studies met the inclusion criteria. BA was associated with a clinical improvement rate of 65% and favorable outcomes in 51% of patients. Hemorrhagic complications occurred in 1.5%, ischemic complications in 5%, and the mortality rate was 20%. Radiological improvement was achieved in 93% of BA cases, with a retreatment rate of 11%. Nimodipine showed clinical improvement in 56% of cases and favorable outcomes in 57%, with a 16% rate of ischemic complications and a mortality rate of 14%. Nicardipine had the highest rates of clinical improvement (73.5%) and favorable outcomes (85%), with a mortality rate of 6%. Verapamil showed clinical improvement in 44% of cases and a mortality rate of 17%. Retreatment rates were 26% for nimodipine, 46% for nicardipine, and 45% for verapamil. BA and IA CCBs are both effective in treating cerebral vasospasm. BA provides high radiological improvement but is associated with high complication and mortality rates. IA CCBs, particularly nicardipine, offer good clinical and radiological outcomes with lower complication rates but require more frequent retreatments. Further randomized trials are needed to optimize treatment strategies.

Indexed as

Angioplasty, BalloonCalcium Channel BlockersVasospasm, IntracranialHumansNimodipineSubarachnoid HemorrhageTreatment OutcomeCalcium Channel BlockersNimodipineBalloon angioplastyIntra-arterial calcium channel blockersMeta-analysisVasospasm

Identifiers

PMID41148372

What OpenQuestion holds

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Registered trials

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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.