Treatment practice of vasospasm during endovascular thrombectomy

• Verfasst von: Jesser, Jessica [VerfasserIn]
• Verfasst von: Nguyen, Thanh [VerfasserIn]
• Verfasst von: Dmytriw, Adam A. [VerfasserIn]
• Verfasst von: Yamagami, Hiroshi [VerfasserIn]
• Verfasst von: Miao, Zhongrong [VerfasserIn]
• Verfasst von: Sommer, Louisa Johanna [VerfasserIn]
• Verfasst von: Stockero, Andrea [VerfasserIn]
• Verfasst von: Pfaff, Johannes Alex Rolf [VerfasserIn]
• Verfasst von: Ospel, Johanna [VerfasserIn]
• Verfasst von: Goyal, Mayank [VerfasserIn]
• Verfasst von: Patel, Aman B. [VerfasserIn]
• Verfasst von: Pereira, Vitor Mendes [VerfasserIn]
• Verfasst von: Hanning, Uta [VerfasserIn]
• Verfasst von: Meyer, Lukas [VerfasserIn]
• Verfasst von: Zwam, Wim H. van [VerfasserIn]
• Verfasst von: Bendszus, Martin [VerfasserIn]
• Verfasst von: Wiesmann, Martin [VerfasserIn]
• Verfasst von: Möhlenbruch, Markus Alfred [VerfasserIn]
• Verfasst von: Weyland, Charlotte Sabine [VerfasserIn]
• Titel: Treatment practice of vasospasm during endovascular thrombectomy
• Titelzusatz: an international survey
• Verf.angabe: Jessica Jesser, Thanh Nguyen, Adam A. Dmytriw, Hiroshi Yamagami, Zhongrong Miao, Louisa Johanna Sommer, Andrea Stockero, Johannes Alex Rolf Pfaff, Johanna Ospel, Mayank Goyal, Aman B. Patel, Vitor Mendes Pereira, Uta Hanning, Lukas Meyer, Wim H. van Zwam, Martin Bendszus, Martin Wiesmann, Markus Möhlenbruch, Charlotte Sabine Weyland
• E-Jahr: 2023
• Jahr: December 19, 2023
• Umfang: 7 S.
• Illustrationen: Illustrationen
• Fussnoten: Vorab veröffentlicht: 19. Dezember 2023 ; Gesehen am 13.5.2024
• Titel Quelle: Enthalten in: Stroke and vascular neurology
• Ort Quelle: London : BMJ, 2016
• Jahr Quelle: 2023
• Band/Heft Quelle: (2023) online ahead of print, Seite 1-7
• ISSN Quelle: 2059-8696
• DOI: doi:10.1136/svn-2023-002788
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: complication
• Sach-SW: stroke
• Sach-SW: thrombectomy
• K10plus-PPN: 1888292989

Abstract

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.