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. Data are available on reasonable request.

中文翻译：

---

血管内血栓切除术中血管痉挛的治疗实践：一项国际调查

背景和目的 血管痉挛作为血管内卒中治疗（EVT）期间并发症的临床重要性和治疗尚未得到充分研究。我们试图调查当前专家对 EVT 期间医源性血管痉挛的神经干预和治疗策略的意见。方法 我们进行了一项匿名国际在线调查（2023 年 4 月 4 日至 2023 年 5 月 15 日），探讨从事 EVT 的神经介入医生 (NI) 的治疗标准。展示了 EVT 期间发生血管痉挛患者的几个说明性病例。根据 NI 关于 EVT 后血管痉挛对患者结局的潜在影响的意见，使用描述性分析对两个研究组进行了比较。结果 总共有来自 56 个国家的 534 名 NI 做出了回应，其中 51.5% 的人进行了 > 200 次 EVT。 52.6%（第 1 组）认为血管痉挛是一种可能影响患者预后的并发症，而 47.4%（第 2 组）则没有。第 1 组的医生在 EVT 期间更经常在导管冲洗中添加血管扩张剂（43.7% vs 33.9%，p=0.033），并且更经常使用血管扩张剂治疗严重的大血管血管痉挛（75.3% vs 55.9%；p<0.001），如与第 2 组相比，颅外血管痉挛（61.4% vs 36.5%，p<0.001）和颅内中等血管血管痉挛（27.1% vs 11.2%，p<0.001）。对于 EVT 期间的中型血管闭塞，研究组表现出不同的治疗策略。第2组更频繁地立即继续EVT，而不首先开始治疗血管痉挛(9.6％vs 21.1％，p＜0.001)。结论 NI 之间对于 EVT 期间血管痉挛的临床相关性及其处理存在分歧。在将血管痉挛视为相关并发症的组中，以及在存在大血管血管痉挛的情况下继续进行 EVT 的不同干预策略的组中，使用预防性和主动血管扩张剂治疗的可能性较高。可根据合理要求提供数据。