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(Stroke. 2009;40:3403.)
© 2009 American Heart Association, Inc.

Research Letters

Do Endothelin-Receptor Antagonists Prevent Delayed Neurological Deficits and Poor Outcomes After Aneurysmal Subarachnoid Hemorrhage?

A Meta-Analysis

From the Department of Critical Care Medicine (A.K.), Clinical Neurosciences & Hotchkiss Brain Institute, University of Calgary, Canada; and the Department of Medicine (J.F.), Michigan State University, East Lansing.

Correspondence to Andreas Kramer, Department of Critical Care Medicine, University of Calgary, AB, T3H 5B5 Canada. E-mail andreas.kramer{at}albertahealthservices.ca

Background and Purpose— Delayed ischemic neurological deficits (DINDs) contribute to poor outcomes after aneurysmal subarachnoid hemorrhage (SAH). Endothelin-1 is an important mediator involved in the development of vasospasm.

Methods— We performed a systematic review and meta-analysis of randomized controlled trials assessing the use of endothelin-receptor antagonists (ETRAs) in patients with SAH.

Results— Three studies met eligibility criteria, enrolling 867 patients. ETRAs significantly reduced the occurrence of DINDs (OR 0.68 [0.49 to 0.95]) and radiographic vasospasm (OR 0.31 [0.19 to 0.49]), but did not have any impact on mortality (OR 1.09 [0.69 to 1.72]) or poor neurological outcomes (OR 0.87 [0.63 to 1.20]). Any benefit of ETRAs may have been partially offset by adverse effects, including hypotension(OR 2.39 [1.37 to 4.17]) and pulmonary complications (OR 2.12 [1.51 to 2.98]).

Conclusions— Although ETRAs reduce radiographic vasospasm and DINDs, there is currently no evidence that they improve outcomes.

Key Words: neurocritial care • SAH • subarachnoid hemorrhage • vasospasm • endothelin

This article has been cited by other articles:

				M. D.I. Vergouwen Effect of Endothelin-Receptor Antagonists on Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage Remains Unclear Stroke, December 1, 2009; 40(12): e714 - e714. [Full Text] [PDF]