22. European Stroke Conference 580 © 2013 S. Karger AG, Basel Scientific Programme 28 Meta-analysis and reviews Accuracy of spot sign on CTA as predictor of haematoma enlargement after acute spontaneous intracerebral haemorrhage. A systematic review. A. Del Guidice1, D. D’Amico2, J. Sobesky3, I. Wellwood4 Centre for Stroke Research Berlin, Charité-Universitätsmedizin, Berlin, GERMANY1, Depart-ment of Neurosciences, S. Maria della Misericordia University Hospital, Udine, ITALY2, Centre for Stroke Research Berlin, Charité-Universitätsmedizin, Berlin, GERMANY3, Centre for Stroke Re-search Berlin, Charité-Universitätsmedizin, Berlin, GERMANY4 Background: A common early complication of intracerebral haemorrhage (ICH) is haematoma en-largement (HE), which is a strong independent predictor of poor outcome. There is no gold standard to accurately predict HE. The presence of contrast extravasation within the haematoma on comput-ed tomogram angiography (CTA), the so-called “spot sign”, seems a particularly promising marker. We examined the following research question: In the adult population with acute spontaneous ICH, how accurately can the presence of the “spot sign” predict HE on follow-up imaging and thus poor outcome? Methods: A systematic review of the literature in PubMed and Embase databases from 1980 to end May 2012. We included all studies involving humans ≥ 18 years old, with spontaneous ICH, evaluated with a CTA and follow-up CT scans, reporting any measure of clinical outcome, and reporting or allowing calculation of accuracy measures of the “spot sign” in predicting HE and clin-ical outcome. Baseline characteristics, accuracy measures and effect measures, as well as bias as-sessment were calculated and reported according to PRISMA recommendations. Quality assessment was performed. Results: 259 potentially relevant studies were identified. Six studies, including 709 patients, were selected. Studies varied substantially in terms of size (n= 39 – 228), methodological quality, definition of terms, outcomes selected and results. For the radiological outcome, the only outcome consistently available, accuracy ranged from 56 – 90%. High heterogeneity was demon-strated (I2 = 94% for radiological outcome) with substantial potential for bias. Conclusion: Studies of the spot sign are diverse and therefore complex to interpret. The research question could not be answered due to heterogeneity and potential for bias in the selected studies. Further appropriately powered studies using standardized definitions and taking into account all predictors of HG are re-quired. 27 Meta-analysis and reviews Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage: an updated meta-analy-sis M.I. Baharoglu1, M.R. Germans2, G.J.E. Rinkel3, A. Algra4, Y.B.W.E.M. Roos5 Academic Medical Centre, Amsterdam, THE NETHERLANDS1, Academic Medical Centre, Amsterdam, THE NETHERLANDS2, University Medical Centre Utrecht, Utrecht, THE NETHER-LANDS3, Julius Centre for health sciences and primary care/ University Medical Centre Utrecht, Utrecht, THE NETHERLANDS4, Academic Medical Centre, Amsterdam, THE NETHERLANDS5 Background: Rebleeding is an important cause of death and disability in patients with aneurysmal subarachnoid haemorrhage (aSAH). Preventing rebleeding could thus improve clinical outcome. Re-bleeding is probably related to dissolution of the blood clot at the site of aneurysm rupture by natu-ral fibrinolysis. We aimed to assess the effect of antifibrinolytic (AF) treatment in aSAH. Methods: We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, and refer-ence lists for randomised trials comparing oral or intravenous AF drugs with control in patients with SAH of suspected aneurysmal cause. Two independent reviewers performed the search, selected trials, extracted data, and assessed trial quality. The primary outcome measure was poor outcome (death, vegetative state, or severe disability). Secondary outcome measures were rates of rebleed-ing, cerebral ischaemia, and hydrocephalus. Subgroup analyses were performed on placebo vs. open studies and concomitant preventative treatment for cerebral ischemia according to treatment dura-tion (<72 hours vs. >72 hours). Results: Ten trials totalling 1904 patients were included. Risk ratio (RR) for poor outcome was 1.02 (95% confidence limits (CL) 0.91 - 1.15) and 1.00 (95% CL 0.85 - 1.18) for death from all causes. Short-term treatment with concomitant cerebral ischaemia prevention showed an RR for poor out-come of 0.83 (95% CL 0.52 - 1.35). AF treatment reduced re-bleeding rate (RR 0.65, 95% CL 0.44 - 0.97), whereas the cerebral ischaemia rate was increased (RR 1.41, 95% CL 1.04 - 1.91). No effect on hydrocephalus rate was found (RR 1.11, 95% CL 0.90 - 1.36). Conclusion: Antifibrinolytic treatment does not improve clinical outcome of patients with aneurys-mal subarachnoid haemorrhage and can not be recommended for routine use. Results of more recent studies with short-term treatment are promising, but not conclusive. Therefore further randomised trials with short-term treatment and up-to-date SAH management are needed.
Karger_ESC London_2013
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