Milo Hollingworth1, Peng Roc Chen2, Antony J P Goddard3, Alan Coulthard4, Michael Söderman5, Ketan R Bulsara6. 1. Department of Neurosurgery, Yale University, New Haven, Connecticut, USA; University College London, London, United Kingdom. Electronic address: milohollingworth@gmail.com. 2. University of Texas Medical School at Houston, Houston, Texas, USA. 3. Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom. 4. University of Queensland, Brisbane, Australia. 5. Karolinska Hospital and Institute, Stockholm, Sweden. 6. Department of Neurosurgery, Yale University, New Haven, Connecticut, USA.
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 χ(2) 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.
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 χ(2) 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.
Authors: Miriam Weiss; Walid Albanna; Catharina Conzen-Dilger; Nick Kastenholz; Katharina Seyfried; Hani Ridwan; Martin Wiesmann; Michael Veldeman; Tobias Philip Schmidt; Murad Megjhani; Henna Schulze-Steinen; Hans Clusmann; Marinus Johannes Hermanus Aries; Soojin Park; Gerrit Alexander Schubert Journal: Stroke Date: 2022-06-08 Impact factor: 10.170
Authors: Leana Mahmoud; Andrew R Zullo; Caitlyn Blake; Xing Dai; Bradford B Thompson; Linda C Wendell; Karen L Furie; Michael E Reznik; Ali Mahta Journal: World Neurosurg Date: 2021-11-11 Impact factor: 2.210