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Prediction of Delayed Cerebral Ischemia with Cerebral Angiography: A Meta-Analysis

Gyanendra Kumar1, Oana M Dumitrascu2, Chia-Chun Chiang3

  • 1Division of Cerebrovascular Diseases, Department of Neurology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA. kumar.gyanendra@mayo.edu.

Neurocritical Care
|July 13, 2018
PubMed

Insights

Transcranial Doppler (TCD) is a better predictor of delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH) than cerebral angiography. Angiography shows low accuracy for predicting DCI, while TCD demonstrates moderate accuracy.

Area of Science:

  • Neurology
  • Radiology
  • Critical Care Medicine

Background:

  • Cerebral catheter angiography is the standard for diagnosing cerebral artery vasospasm in aneurysmal subarachnoid hemorrhage (SAH).
  • Delayed cerebral ischemia (DCI) is a major complication following SAH.
  • Previous meta-analysis assessed transcranial Doppler (TCD) for DCI prediction; analogous data for angiography is lacking.

Purpose of the Study:

  • To collate and analyze data on the prediction of DCI using cerebral angiography in SAH patients.
  • To reconcile the predictive accuracy of cerebral angiography against TCD for DCI.
  • To report the quality of evidence for both diagnostic tools in SAH.

Main Methods:

  • Systematic literature search of PUBMED, Cochrane database, and clinicaltrials.gov for relevant studies.
  • Random-effects meta-analysis of 15 studies (n=5463) evaluating cerebral angiography for vasospasm diagnosis and DCI prediction in SAH.
  • Comparison of diagnostic accuracy metrics (sensitivity, specificity, PPV, NPV) between cerebral angiography and TCD.

Main Results:

  • Cerebral angiography showed low test accuracy for DCI prediction: Sensitivity 57%, Specificity 68%, PPV 32%, NPV 90%.
  • TCD demonstrated moderate test accuracy: Sensitivity 90%, Specificity 71%, PPV 57%, NPV 92%.
  • TCD is a more accurate predictor of DCI compared to cerebral angiography in SAH.

Conclusions:

  • TCD evidence of vasospasm is a superior predictor of DCI than angiographic vasospasm.
  • Cerebral angiography has limited value in predicting DCI in SAH patients.
  • Further comparative effectiveness studies are needed to define the optimal use of these diagnostic tools.
Abstract

Keywords:
Brain ischemiaCerebral angiographyCerebral vasospasmMeta-analysisTranscranial Doppler sonography

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