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J Neurointerv Surg. 2015 Jun;7(6):408-11. doi: 10.1136/neurintsurg-2014-011223. Epub 2014 May 7.

Results of a national cerebrovascular neurosurgery survey on the management of cerebral vasospasm/delayed cerebral ischemia.

Author information

1
Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
2
University of Chicago, Chicago, Illinois, USA.
3
University of Texas, Medical School at Houston, Houston, Texas, USA.
4
Columbia University, Neurological Institute of New York, New York, New York, USA.
5
Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Abstract

OBJECTIVE:

Following aneurysmal subarachnoid hemorrhage, cerebral vasospasm/delayed cerebral ischemia accounts for significant morbidity and mortality. In this paper we provide the first glimpse of actual practice in the management of cerebral vasospasm in the USA.

METHODS:

All active members of the Joint American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Cerebrovascular Section were emailed the survey. The responses were collected anonymously.

RESULTS:

The response rate for this survey was 44% (177 responses/400 total members). Non-responders were characterized by the fact that multiple responders were not obtained from practices that had multiple providers with uniform practice. Both high-volume and low-volume centers were equally represented. Optimizing medical management is first-line treatment in practice. Although there is some variability regarding screening methods, the greatest variability occurs with regard to the choice of intra-arterial treatment drug and dose. There is also considerable variability in the perceived effectiveness of endovascular treatment for vasospasm.

CONCLUSIONS:

In this preliminary glimpse of actual cerebral vasospasm management practice in the USA, two salient points emerge: (1) there is considerable variability in intra-arterial therapies for vasospasm; and (2) there are major differences in the perceived effectiveness of these therapies. Standardization of intra-arterial therapies may contribute to improved outcomes. A prospective randomized trial evaluating endovascular treatment for cerebral vasospasm is needed.

KEYWORDS:

Aneurysm; Angioplasty; Intervention

PMID:
24811742
DOI:
10.1136/neurintsurg-2014-011223
[Indexed for MEDLINE]

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