Intracranial aneurysms and delayed cerebral ischemia: Decades of evidence on unexplored event
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Ruslan Akhmedullin 1 , Byron Crape 1 , Azat Shpekov 2 , Ruslan Kremnev 3 , Chingiz Nurimanov 4 , Crina Peterson 5 , Abduzhappar Gaipov 1 *
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1 Nazarbayev University School of Medicine, Astana, KAZAKHSTAN2 Green Clinic, Astana, KAZAKHSTAN3 Multidisciplinary Regional Hospital, Petropavl, KAZAKHSTAN4 National Center for Neurosurgery, Astana, KAZAKHSTAN5 University of Minnesota, Minneapolis, MN, USA* Corresponding Author

Abstract

Background: The current literature reveals a female predominance among delayed cerebral ischemia (DCI) cases and speculates the fluctuations in sex-specific hormones as an explanation for the disparity. We aimed to address the following simple question: Do older females undergoing unruptured aneurysm (UA) treatment have higher chances for DCI?
Materials and methods: We conducted a literature search of PubMed, Scopus, and Web of Science from 1980 to 2024. We identified studies on evident DCI in patients who underwent treatment for UA and additionally provided another DCI case following surgery in a patient with a UA. We pooled all evidence and examined sex differences using Bayesian hierarchical models with 4 chains of 4,000 Markov Chain Monte Carlo samples.
Results: Of the 5,293 publications identified, 43 were selected for the full-text review. Sixteen case series were eligible for inclusion. Modelled DCI posterior mean odds ratio (OR) was 2.4 (0.4-17.8) and 0.4 (0.1-2.3) for females and males, respectively, with posterior probabilities of 87% and 17%, respectively, for the OR exceeding 1.0.
Conclusion: Our findings suggest females have a substantially greater risk for DCI, which suggests a potential impact of sex-specific hormonal variations, further justifying the observed predominance. Furthermore, we suspect that prolonged drying of the exposed vessels contributes to the onset of DCI.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Review Article

ELECTRON J GEN MED, Volume 22, Issue 4, August 2025, Article No: em666

https://doi.org/10.29333/ejgm/16517

Publication date: 01 Jul 2025

Online publication date: 18 Jun 2025

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