Results of an international survey on the investigation and endovascular management of cerebral vasospasm and delayed cerebral ischemia

Hollingworth, Milo, Chen, Peng Roc, Goddard, Antony J. P., Coulthard, Alan, Söderman, Michael and Bulsara, Ketan R. (2015) Results of an international survey on the investigation and endovascular management of cerebral vasospasm and delayed cerebral ischemia. World Neurosurgery, 83 6: 1120-1126.e1. doi:10.1016/j.wneu.2015.01.036

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Author Hollingworth, Milo
Chen, Peng Roc
Goddard, Antony J. P.
Coulthard, Alan
Söderman, Michael
Bulsara, Ketan R.
Title Results of an international survey on the investigation and endovascular management of cerebral vasospasm and delayed cerebral ischemia
Journal name World Neurosurgery   Check publisher's open access policy
ISSN 1878-8769
1878-8750
Publication date 2015-06-01
Sub-type Article (original research)
DOI 10.1016/j.wneu.2015.01.036
Open Access Status File (Author Post-print)
Volume 83
Issue 6
Start page 1120
End page 1126.e1
Total pages 8
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Collection year 2016
Language eng
Formatted abstract
Background: Delayed cerebral ischemia (DCI) is a major cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage. Endovascular management of this condition offers a new hope in preventing adverse outcome; however, a uniform standard of practice is lacking owing to a paucity of clinical trials. We conducted an international survey on the use of investigative and endovascular techniques in the treatment of DCI to assess the variability of current practice.

Methods: Neurovascular neurosurgeons and neuroradiologists were contacted through professional societies from America, United Kingdom, Europe, and Australasia. Members were invited to complete a 13-item questionnaire regarding screening techniques, first-line and second-line therapies in endovascular intervention, and the role of angioplasty. Answers were compared using χ2 testing for nonparametric data.

Results: Data from 344 respondents from 32 countries were analyzed: 167 non-United States and 177 U.S. respondents. More than half of all clinicians had 10+ years of experience in units with a mixture of higher and lower case volumes. Daily transcranial Doppler ultrasonography was the most commonly used screening technique by both U.S. (70%) and non-U.S. (53%) practitioners. Verapamil was the most common first-line therapy in the United States, whereas nimodipine was most popular in non-U.S. countries. Angioplasty was performed by 83% of non-U.S. and 91% of U.S. clinicians in the treatment of vasospasm; however, more U.S. clinicians reported using angioplasty for distal vasospasm.

Conclusions: Treatment practices for DCI vary considerably, with the greatest variability in the choice of agent for intra-arterial therapy. Our data demonstrate the wide variation of approaches in use at present. However, without further clinical trials and development of a uniform standard of best practice, variability in treatment and outcome for DCI is likely to continue.
Keyword Angioplasty
Cerebral vasospasm
Delayed cerebral ischemia
Intra-arterial treatment
Subarachnoid hemorrhage
Survey
Transcranial Doppler
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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