Introduction Vasospasm and delayed cerebral ischemia (DCI) are the leading causes of morbidity and mortality after intracranial aneurysmal subarachnoid hemorrhage (aSAH). Vasospasm detection, prevention and management, especially endovascular management varies from center to center and lacks standardization.
Aim of Study We aimed to evaluate this variability through an international survey on diagnosis and endovascular management of vasospasm.
Methods A 100 question anonymous online survey was designed to evaluate the practice patterns between December 2021 and September 2022. Endovascular neurosurgeons, neuroradiologists and neurologists were contacted through email and professional societies (SNIS and ESMINT). Answers were recorded.
Results A total of 201 physicians (25% [50/201] USA and 75% non-USA) completed the survey over 10 months, 42% had >7years of experience, 92% were male, median age was 40 (IQR 35–46). Both high-volume and low-volume centers were represented. Daily transcranial Doppler was the most common screening method (75%) for vasospasm. In cases of symptomatic vasospasm despite optimal medical management, endovascular treatment was directly considered by 58% physicians. The most common reason to initiate endovascular treatment was clinical deficits associated with proven vasospasm/DCI in 89%. The choice of endovascular treatment and its efficacy was highly variable. Nimodipine was the most common first-line intra-arterial therapy (40%). Mechanical angioplasty was considered the most effective endovascular treatment by 65% of neurointerventionalists.
Conclusion Our study highlights the considerable heterogeneity among the neurointerventional community regarding vasospasm diagnosis and endovascular management. Randomized trials and guidelines are needed to improve standard of care, determine optimal management approaches and track.
Disclosure of Interest Dr Guenego reports consultancy for Rapid Medical and Phenox
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