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

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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.

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Funding

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Authors and Affiliations

  1. Division of Cerebrovascular Diseases, Department of Neurology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA

    Gyanendra Kumar, Chia-Chun Chiang & Cumara B. O’Carroll

  2. Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Oana M. Dumitrascu

  3. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA

    Andrei V. Alexandrov

Authors
  1. Gyanendra Kumar
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  2. Oana M. Dumitrascu
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  3. Chia-Chun Chiang
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  4. Cumara B. O’Carroll
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  5. Andrei V. Alexandrov
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Contributions

GK contributed to study conception, design, acquisition of data, analysis, statistical analysis, writing of manuscript, critical revision, study supervision, and final approval. OMD helped in acquisition of data, analysis, writing of manuscript, critical revision, and final approval. CCC contributed to acquisition of data, analysis, writing of manuscript, critical revision, and final approval. COC involved in analysis, supervision, writing and critical revision, and final approval. AVA helped in analysis, supervision, writing and critical revision, and final approval.

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Correspondence to Gyanendra Kumar.

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Kumar, G., Dumitrascu, O.M., Chiang, CC. et al. Prediction of Delayed Cerebral Ischemia with Cerebral Angiography: A Meta-Analysis. Neurocrit Care 30, 62–71 (2019). https://doi.org/10.1007/s12028-018-0572-2

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