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Results of a national cerebrovascular neurosurgery survey on the management of cerebral vasospasm/delayed cerebral ischemia
  1. Ketan R Bulsara1,
  2. Murat Günel1,
  3. Sepideh Amin-Hanjani2,
  4. Pen Roc Chen3,
  5. E Sander Connolly4,
  6. Robert M Friedlander5
  1. 1Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2University of Chicago, Chicago, Illinois, USA
  3. 3University of Texas, Medical School at Houston, Houston, Texas, USA
  4. 4Columbia University, Neurological Institute of New York, New York, New York, USA
  5. 5Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Ketan R Bulsara, Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, TMP 4, New Haven, CT 06524, USA; ketan.bulsara{at}yale.edu

Abstract

Objective Following aneurysmal subarachnoid hemorrhage, cerebral vasospasm/delayed cerebral ischemia accounts for significant morbidity and mortality. In this paper we provide the first glimpse of actual practice in the management of cerebral vasospasm in the USA.

Methods All active members of the Joint American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Cerebrovascular Section were emailed the survey. The responses were collected anonymously.

Results The response rate for this survey was 44% (177 responses/400 total members). Non-responders were characterized by the fact that multiple responders were not obtained from practices that had multiple providers with uniform practice. Both high-volume and low-volume centers were equally represented. Optimizing medical management is first-line treatment in practice. Although there is some variability regarding screening methods, the greatest variability occurs with regard to the choice of intra-arterial treatment drug and dose. There is also considerable variability in the perceived effectiveness of endovascular treatment for vasospasm.

Conclusions In this preliminary glimpse of actual cerebral vasospasm management practice in the USA, two salient points emerge: (1) there is considerable variability in intra-arterial therapies for vasospasm; and (2) there are major differences in the perceived effectiveness of these therapies. Standardization of intra-arterial therapies may contribute to improved outcomes. A prospective randomized trial evaluating endovascular treatment for cerebral vasospasm is needed.

  • Aneurysm
  • Angioplasty
  • Intervention
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