Interventional Neuroradiology Department, Hôpital Erasme - Hôpital Universitaire de Bruxelles (HUB) - Université Libre de Bruxelles (ULB), Bruxelles, Belgium
Department of Medicine - Division of Neurology, The Ottawa Hospital - Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada.
J Neurointerv Surg. 2024 Jun 17;16(7):677-683. doi: 10.1136/jnis-2023-020544.
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.
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.
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.
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.
血管痉挛和迟发性脑缺血（DCI）是颅内动脉瘤性蛛网膜下腔出血（aSAH）后发病率和死亡率的主要原因。血管痉挛的检测、预防和治疗，特别是血管内治疗，因中心而异，缺乏标准化。我们旨在通过一项关于神经介入医生如何处理血管痉挛诊断和血管内治疗的国际调查来评估这种变异性。
我们设计了一项匿名在线调查，共 100 个问题，以评估 2021 年 12 月至 2022 年 9 月期间的实践模式。我们通过电子邮件联系了血管神经外科医生、神经放射科医生和神经科医生，还通过两个专业协会——神经介入外科学会（SNIS）和欧洲微创神经治疗学会（ESMINT）进行了联系。我们记录了医生对调查问题的回答。
共有 201 名医生（25%[50/201]来自美国，75%来自非美国）在 10 个月内完成了调查，42%的医生有超过 7 年的经验，92%是男性，中位年龄为 40 岁（IQR 35-46）。高容量和低容量中心都有代表。每日经颅多普勒是最常见的血管痉挛筛查方法（75%）。在尽管进行了最佳的药物治疗但仍出现症状性血管痉挛的情况下，58%的医生直接考虑进行血管内治疗。开始血管内治疗的最常见原因是与 DCI 相关的已知血管痉挛的临床缺陷，占 89%。血管内治疗的选择及其疗效差异很大。尼莫地平是最常见的一线动脉内治疗方法（40%）。机械血管成形术被 65%的神经介入医生认为是最有效的血管内治疗方法。
我们的研究强调了神经介入界在血管痉挛诊断和血管内治疗方面存在相当大的异质性。需要随机试验和指南来改善护理标准，确定最佳管理方法并跟踪结果。
