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Original research
Diagnosis and endovascular management of vasospasm after aneurysmal subarachnoid hemorrhage — survey of real-life practices
  1. Adrien Guenego1,
  2. Robert Fahed2,
  3. Aymeric Rouchaud3,4,
  4. Gregory Walker5,5,
  5. Tobias D Faizy6,
  6. Peter B Sporns7,
  7. Mohamed Aggour8,
  8. Pascal Jabbour9,
  9. Andrea M Alexandre10,
  10. Pascal John Mosimann11,
  11. Adam A Dmytriw12,13,
  12. Noémie Ligot14,
  13. Niloufar Sadeghi15,
  14. Chengbo Dai16,
  15. Ameer E Hassan17,
  16. Vitor M Pereira13,
  17. Justin Singer18,
  18. Jeremy J Heit19,
  19. Fabio Silvio Taccone20,
  20. Michael Chen21,
  21. Jens Fiehler22,
  22. Boris Lubicz1
  23. On behalf of the Research Committee of the European Society of Minimally Invasive Neurological Therapy (ESMINT)
  1. 1 Interventional Neuroradiology Department, Hôpital Erasme - Hôpital Universitaire de Bruxelles (HUB) - Université Libre de Bruxelles (ULB), Bruxelles, Belgium
  2. 2 Department of Medicine - Division of Neurology, The Ottawa Hospital - Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
  3. 3 Interventional neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
  4. 4 Univsersity of Limoges, CNRS, XLIM, UMR 7252, Limoges, France
  5. 5 Department of Medicine – Division of Neurology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
  6. 6 Radiology, Stanford University School of Medicine, Stanford, California, USA
  7. 7 Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
  8. 8 Department of Radiology, The Royal London Hospital, London, UK
  9. 9 Neurological surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  10. 10 UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy
  11. 11 Neuroradiology Division, University Medical Imaging TorontoJoint Department of Medical ImagingUniversity Health Networks and University of TorontoToronto Western Hospital, Toronto, Ontario, Canada
  12. 12 Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  13. 13 Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
  14. 14 Department of Neurology, Hôpital Erasme - Hôpital Universitaire de Bruxelles (HUB) - Université Libre de Bruxelles (ULB), Brussels, Belgium
  15. 15 Department of Radiology and Neuroradiology, Hôpital Erasme - Hôpital Universitaire de Bruxelles (HUB) - Université Libre de Bruxelles (ULB), Brussels, Belgium
  16. 16 Department of Neurology, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
  17. 17 Department of Neurology, Valley Baptist Health System Inc, Harlingen, Texas, USA
  18. 18 Neurosurgery, Spectrum Health Michigan State University College of Human Medicine Internal Medicine Residency Program, Grand Rapids, Michigan, USA
  19. 19 Radiology, Neuroadiology and Neurointervention Division, Stanford University, Stanford, California, USA
  20. 20 Department of Intensive Care, Hospital Erasme, Hôpital Erasme - Hôpital Universitaire de Bruxelles (HUB) - Université Libre de Bruxelles (ULB), Brussels, Belgium
  21. 21 Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
  22. 22 Department of Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
  1. Correspondence to Dr Adrien Guenego, Interventional Neuroradiology Department, Centre Universitair Bruxelles Hôpital Erasme, Bruxelles 1070, Belgium; adrienguenego{at}gmail.com

Abstract

Background 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. We aimed to evaluate this variability via an international survey of how neurointerventionalists approach vasospasm diagnosis and endovascular management.

Methods We designed an anonymous online survey with 100 questions to evaluate practice patterns between December 2021 and September 2022. We contacted endovascular neurosurgeons, neuroradiologists and neurologists via email and via two professional societies – the Society of NeuroInterventional Surgery (SNIS) and the European Society of Minimally Invasive Neurological Therapy (ESMINT). We recorded the physicians’ responses to the survey questions.

Results A total of 201 physicians (25% [50/201] USA and 75% non-USA) completed the survey over 10 months, 42% had >7 years 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% of 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 outcomes.

  • aneurysm
  • subarachnoid

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • X @GuenegoAdrien, @PascalJabbourMD, @AdamDmytriw, @VitorMendesPer1, @JeremyHeitMDPHD, @dr_mchen, @Fie0815

  • Contributors AG, RF, AR, GW, BL made substantial contributions to the conception and design of the work, drafted the manuscript for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. TDF, PBS, MA, PJ, AMA, PJM, AAD, NL, NS, CD, AEH, VMP, JS, JJH, FST, MC, JF made substantial contributions to the acquisition, analysis, or interpretation of data for the work, made critical revisions for important intellectual content and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.AG is responsible for the overall content as the guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.