Meta-analysis of timing of endovascular aneurysm treatment in subarachnoid haemorrhage: inconsistent results of early treatment within 1 day.

Background and purpose To systematically review and meta-analyse the data on impact of timing of endovascular treatment in aneurysmal subarachnoid haemorrhage (SAH) to determine if earlier treatment is associated with improved clinical outcomes and reduced case fatality. Methods We searched MEDLINE, Cochrane database, EMBASE and Web of Science to identify studies for inclusion. The measures of effect utilised were unadjusted/adjusted ORs. Effect estimates were combined using random effects models for each outcome (poor outcome, case fatality); heterogeneity was assessed using the I 2 index. Subgroup and sensitivity analyses were performed to account for heterogeneity and risk of bias. Results 16 studies met the inclusion criteria. Treatment 1 day (OR=0.40 (95% CI 0.28 to 0.56; I 2 =0%)) but not when compared with treatment at 1–3 days (OR=1.16 (95% CI 0.47 to 2.90; I 2 =81%)). Treatment at 2 =73%; OR=0.71 (95% CI 0.36 to 1.37; I 2 =71%)). Early treatment was associated with similar odds of case fatality compared with later treatment, regardless of how early/late treatment were defined (OR=1.80 (95% CI 0.88 to 3.67; I 2 =34%) for treatment 2 =54%) for treatment 2 =48%) for treatment Conclusions In only 1 of the analyses was there a statistically significant result, which favoured treatment