title: Results of an International Survey on the Investigation and Endovascular Management of Cerebral Vasospasm and Delayed Cerebral Ischemia.
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.
  
  
  METHODS
  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: Department of Neurosurgery, Yale University, New Haven, Connecticut, USA; University College London, London, United Kingdom. Electronic address: milohollingworth@gmail.com.
authors: Milo
authors: M
authors: Hollingworth
authors: University of Texas Medical School at Houston, Houston, Texas, USA.
authors: Peng Roc
authors: PR
authors: Chen
authors: Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom.
authors: Antony J P
authors: AJ
authors: Goddard
authors: University of Queensland, Brisbane, Australia.
authors: Alan
authors: A
authors: Coulthard
authors: Karolinska Hospital and Institute, Stockholm, Sweden.
authors: Michael
authors: M
authors: Söderman
authors: Department of Neurosurgery, Yale University, New Haven, Connecticut, USA.
authors: Ketan R
authors: KR
authors: Bulsara
mesh_terms: D000328:Adult; D044362:Australasia; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019468:Disease Management; D057510:Endovascular Procedures / Q000379:methods; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009485:Neuroradiography / Q000706:statistics & numerical data; D009493:Neurosurgery / Q000706:statistics & numerical data; D009553:Nimodipine / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000601:surgery; D011795:Surveys and Questionnaires; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial; D006113:United Kingdom; D014481:United States; D014665:Vasodilator Agents / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014700:Verapamil / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D009553:Nimodipine; D014700:Verapamil
keywords: Angioplasty; Cerebral vasospasm; Delayed cerebral ischemia; Intra-arterial treatment; Subarachnoid hemorrhage; Survey; Transcranial Doppler