Treatment practice of vasospasm during endovascular thrombectomy: an international survey.

Autor:	Jesser J; Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany., Nguyen T; Neurology, Boston University School of Medicine, Boston, Massachusetts, USA., Dmytriw AA; St. Michael's Hospital, Departments of Medical Imaging and Neurosurgery, Neurovascular Center, University of Toronto, Toronto, Ontario, Canada.; Neuroendovascular Program, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA., Yamagami H; Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan., Miao Z; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China., Sommer LJ; Neuroradiology, University Hospital Aachen, Aachen, Germany., Stockero A; Neuroradiology, University Hospital Aachen, Aachen, Germany., Pfaff JAR; University Insitute for Neuroradiology at PMU, Uniklinikum Salzburg-Christian-Doppler-Klinik, Salzburg, Austria., Ospel J; Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada., Goyal M; Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada., Patel AB; Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA., Pereira VM; Department of Neurosurgery, Unity Health Toronto, Toronto, Ontario, Canada., Hanning U; Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Hamburg, Germany., Meyer L; Diagnostic and Interventional Neuroradiology, Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Hamburg, Germany., van Zwam WH; Radiology, Maastricht University Medical Center, Maastricht, The Netherlands., Bendszus M; Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany., Wiesmann M; Neuroradiology, University Hospital Aachen, Aachen, Germany., Möhlenbruch M; Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany., Weyland CS; Neuroradiology, University Hospital Aachen, Aachen, Germany cweyland@ukaachen.de.
Jazyk:	angličtina
Zdroj:	Stroke and vascular neurology [Stroke Vasc Neurol] 2024 Nov 05; Vol. 9 (5), pp. 490-496. Date of Electronic Publication: 2024 Nov 05.
DOI:	10.1136/svn-2023-002788
Abstrakt:	Background and Aim: The clinical importance and management of vasospasm as a complication during endovascular stroke treatment (EVT) has not been well studied. We sought to investigate current expert opinions in neurointervention and therapeutic strategies of iatrogenic vasospasm during EVT. Methods: We conducted an anonymous international online survey (4 April 2023 to 15 May 2023) addressing treatment standards of neurointerventionalists (NIs) practising EVT. Several illustrative cases of patients with vasospasm during EVT were shown. Two study groups were compared according to the NI's opinion regarding the potential influence of vasospasm on patient outcome after EVT using descriptive analysis. Results: In total, 534 NI from 56 countries responded, of whom 51.5% had performed >200 EVT. Vasospasm was considered a complication potentially influencing the patient's outcome by 52.6% (group 1) whereas 47.4% did not (group 2). Physicians in group 1 more often added vasodilators to their catheter flushes during EVT routinely (43.7% vs 33.9%, p=0.033) and more often treated severe large-vessel vasospasm with vasodilators (75.3% vs 55.9%; p<0.001), as well as extracranial vasospasm (61.4% vs 36.5%, p<0.001) and intracranial medium-vessel vasospasm (27.1% vs 11.2%, p<0.001), compared with group 2. In case of a large-vessel vasospasm and residual and amenable medium-vessel occlusion during EVT, the study groups showed different treatment strategies. Group 2 continued the EVT immediately more often, without initiating therapy to treat the vasospasm first (9.6% vs 21.1%, p<0.001). Conclusion: There is disagreement among NIs about the clinical relevance of vasospasm during EVT and its management. There was a higher likelihood of use of preventive and active vasodilator treatment in the group that perceived vasospasm as a relevant complication as well as differing interventional strategies for continuing an EVT in the presence of a large-vessel vasospasm. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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