MENA-Adapted Guidelines

Aneurysmal Subarachnoid Hemorrhage

Clinical Recommendations

Evidence-based recommendations adapted for MENA healthcare settings, organized by clinical domain.

Aneurysm Treatment

COR 1 LOE A RL
Adapted from AHA/ASA 2023

We strongly recommend early aneurysm treatment (within 24 hours) to prevent rebleeding, with treatment modality selection based on aneurysm characteristics and local expertise.

MENA-Specific Considerations

Treatment modality availability varies significantly across the region. Larger centers should provide consultation support to smaller facilities.

COR 1 LOE A RL
Adapted from ESO Guidelines

For aneurysms suitable for both surgical and endovascular treatment, we recommend individualized decision-making considering patient factors and institutional expertise.

MENA-Specific Considerations

Many MENA centers have limited endovascular capabilities. Surgical clipping remains the primary option in many settings.

COR EO-Strong LOE C RL
MENA-SINO Original

When immediate definitive treatment is not available, we strongly recommend medical management to prevent rebleeding until transfer can be arranged.

MENA-Specific Considerations

Includes blood pressure control, seizure prophylaxis, and careful monitoring while arranging transfer to specialized centers.

Recommendation Grading System

Class of Recommendation (COR)

1 Strong recommendation - Should be performed
2a Moderate recommendation - Reasonable to perform
2b Weak recommendation - May be considered

Level of Evidence (LOE)

A High-quality evidence from multiple RCTs
B Moderate evidence from single RCT or observational studies
C Expert opinion or case studies

Special Designations

RL Resource-Limited - Requires adaptation for limited resources
EO Expert Opinion - MENA-SINO consensus recommendation