Expert Guidelines Research Articles

A Delphi consensus to standardize the technique of anatomical endoscopic enucleation of prostate: a study by ESUT endoscopic enucleation of prostate study group.

Our objective was to establish a standardized technique for Anatomical Endoscopic Enucleation of Prostate (AEEP) utilizing a consensus statement to provide robust recommendations for urologists who are new to this procedure. The participants were electronically sent a questionnaire in three consecutive rounds. In the second and third rounds, the anonymous aggregate results of the previous round were presented. Experts' feedback and comments were then incorporated to refine existing questions or to explore more controversial topics in greater depth. Forty-one urologists participated in the first round. In the second round, all Round 1 participants received a 22-question survey, resulting in a consensus on 21 items. In the third round, 76% (19/25) of the second-round respondents also participated, reaching a consensus on 22 additional items. The panelists consensually agreed on detaching the urethral sphincter at the beginning of the enucleation and not at the end of the enucleation. To prevent incontinence, it was recommended that the apical mucosa be preserved through various approaches between 11 and 1 o'clock while gently disrupting the lateral lobes in their apical part, avoiding an excess energy delivery approximation to the apical mucosa. To optimize laser AEEP procedures, urologists must follow expert guidelines on equipment and surgical technique, including early apical release, using the 3-lobe technique for enucleation, preserving apical mucosa with appropriate approaches, gently disrupting lateral lobes at their apical regions, and avoiding excessive energy delivery near the apical mucosa. Following these recommendations can lead to improved outcomes and patient satisfaction.

Predicting successful outpatient total shoulder arthroplasty.

Total shoulder arthroplasty (TSA) is increasingly performed safely and efficiently as an outpatient procedure in certain patients. Patient selection is often based on surgeon choice, surgeon expertise, or institutional guidelines. One orthopedic research group released a publicly available shoulder arthroplasty outpatient appropriateness risk calculator that considers patient demographic characteristics and comorbidities with the aim of helping surgeons to predict successful outpatient TSA. This study aimed to retrospectively assess the utility of this risk calculator at our institution. Records were obtained for patients undergoing procedure code 23472 at our institution between January 1, 2018, and March 31, 2021. Patients undergoing anatomic TSA in the hospital setting were included. Records were reviewed for demographic characteristics, comorbidities, American Society of Anesthesiologists classification, and surgery duration. These data were entered into the risk calculator to calculate the likelihood of discharge by postoperative day 1. Charlson Comorbidity Index, complications, reoperations, and readmissions were also collected from patient records. Statistical analyses assessed the model's fit with our patient cohort and compared outcome measures between inpatient and outpatient groups. Of the 792 patients whose records were initially obtained, 289 met the inclusion criteria of anatomic TSA performed in the hospital setting. Of these patients, 7 were excluded because of missing data, leaving 282 patients: 166 (58.9%) in the inpatient group and 116 (41.1%) in the outpatient group. We found no significant differences in mean age (66.4 years in inpatient group vs. 65.1 years in outpatient group, P=.28), Charlson Comorbidity Index (3.48 vs. 3.06, P=.080), or American Society of Anesthesiologists class (2.58 vs. 2.66, P=.19). Surgery time was longer in the inpatient group than the outpatient group (85 minutes vs. 77 minutes, P=.001). Overall complication rates were low (4.2% in inpatient group vs. 2.6% in outpatient group, P=.07). Readmissions and reoperations did not differ between groups. There was no difference in the average percentage likelihood of same-day discharge (55.4% in inpatient group vs. 52.4% in outpatient group, P=.24), and a receiver operating characteristic curve to assess fit with the risk calculator demonstrated an area under the curve of 0.55. The shoulder arthroplasty risk calculator performed similarly to chance when retrospectively predicting discharge within 1 day after TSA in our patients. Complications, readmissions, and reoperations were not higher after outpatient procedures. Risk calculators for determining whether a patient should be admitted after TSA should be used cautiously because they may not provide measurable benefit over the use of surgeon experience and expertise in discharge decision making, and other factors may be relevant in the decision to perform outpatient TSA.

A Survey on the Management of Anomalous Aortic Origins of the Coronary Arteries.

The management of patients with an anomalous aortic origin of a coronary artery (AAOCA) remains controversial despite the publication of the 2017 American Association for Thoracic Surgery (AATS) expert guidelines. We surveyed the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery and the Pediheart.net online community regarding their care of patients with anomalous origins of the right or left coronary from the opposite cusp with inter-arterial courses and compared them to the AATS guidelines. We received 111 complete responses. Four notable variations from the AATS recommendations were identified. Respondents were more likely to use ECG exercise testing than the stress imaging recommended in the AATS guidelines. For a 16-year-old with AAOCA, recommendations for surgery generally followed the AATS guidelines. However, for asymptomatic left AAOCA without signs of ischemia on stress imaging, only 69.4% felt surgery was appropriate or somewhat appropriate. In the setting of a 16-year-old with right AAOCA free from signs or symptoms of ischemia, respondents were more likely to recommend surgery if the patient was a competitive athlete, a topic not directly addressed in the AATS guidelines. After surgical treatment of AAOCA, only 24% of respondents recommended lifelong antiplatelet therapy despite recommendations for this in the AATS guidelines. Respondents recommendations were generally consistent with the 2017 AATS guidelines but with important variations in the use of stress imaging, indications for surgery in asymptomatic left AAOCA, the impact of identification as a competitive athlete and duration of postoperative antiplatelet therapy.

Study on Psycho-social Problems of COVID-19 Affected Young Adults Living in Madakasira Town of Anantapuram District Andhra Pradesh, India

The threat of Covid-19 pandemic was very severe and entire world was placed on lockdown and government imposed social restrictions, quarantine, and self-isolation had detrimental impact on peoples psycho-social health due to increased loneliness, distrust, and reduced social interaction. It interfered with daily functioning and disturbed plan for the future. They confronted with number of new challenges, experienced lack of emotional support, making arrangement for hospital stays and appointments all these made vulnerable. The Covid pandemic made individual to perceive fear, stress, anxiety, depression, dissatisfaction. Poor psycho-social aspects is all about not feeling optimistic about self, not being able to form good relations and unable to be flexible to cope up (WHO, 2022). The main focus of the study was to swot on “Study on psycho-social problems of covid-19 affected young adults living in Madakasira town of Anantapuram district Andhra Pradesh”. Purposive random sampling technique was selected for the study. The respondents were selected from Madakasira urban area of Anantapuram district, Andhra Pradesh. Male and Female who are in the age group of 18-35 years affected with covid-19 will be selected for the study. The group consists of 30 covid-19 affected young adults of 15 males and 15 females from Madakasira town for the study. Covid-19 psycho-social problems questionnaire was developed by the researcher with the guidelines of subject experts it was pre-tested to other sample before going to actual sample. The study found that effects of pandemic on one's psycho-social health people's behavior may greatly affect the pandemic's dynamic by altering the severity, transmission, disease flow, and repercussions. The situation requires raising awareness in public, which can be helpful to deal with the calamity. With adequate support and timely intervention, young people experiencing psycho-social distress may be able to bounce back as individual to recover from the Covid‑19 crisis. Psychosocial preparedness by setting up mental organizations specific for future pandemics is certainly necessary.

Providers Respond to USPSTF Report on Screening for Breast Cancer

Providers Respond to USPSTF Report on Screening for Breast Cancer

Lung cancer and COVID-19: problems and perspectives.

COVID-19 pandemic generated concerns about the healthcare of patients with cancer, not simply because of the formidable impact of COVID-19 patients in the public healthcare system, but also due to the overlapping pathognomonic signs of many forms of lung cancer with lung injuries associated with COVID-19. This report tries to shed light on the issue. We evaluated the great concern of people suffering from lung cancer and also infected with SARS-CoV-2 by discussing evidence and data from current literature. Lung cancer in Italy has represented more than 1 case/4 (27%) in the latest ten years and nevertheless, even due to the concurrence of many complex interplays between COVID-19 and cancer even at the immune level, a consensus protocol and expert guidelines to diagnose and treat lung cancer upon SARS-CoV-2 infection are yet lacking. New insights and consensus panels should be therefore proposed, even at the simplistic level about if priority must be either given to COVID-19 or to cancer therapy.

Rate and determinants of antiviral treatment initiation for patients with HBeAg-negative chronic hepatitis B.

Most clinic attenders with chronic hepatitis B (CHB) are serum HBeAg-negative, and a minority will require suppressive antiviral treatment. Expert guidelines propose schedules for the monitoring of untreated patients, but the recommended frequency of patient review does not reflect recognised demographic determinants of HBeAg-negative chronic hepatitis. Also, the impact of patient ethnicity on risk has not been defined. The aim of our study was to determine the rates and determinants of antiviral treatment initiation in a large multi-ethnic cohort of CHB patients attending a single centre. We undertook a retrospective study using entirely electronic sources of patient information. Treatment initiation dates were identified from electronic pharmacy records. Crude and time-dependent statistical analyses were undertaken to identify rate and risk factors for treatment initiation. Treatment was initiated for 232/1256 (18.5%) patients with rates of 23.2% and 33.2% at 5 and 10 years. An increased risk of treatment was associated with male sex (RR 1.803), older age at presentation (RR 1.027 per year increase) and with non-Black ethnicity (RR 1.654). Patient sex, baseline age and ethnicity also determined risk for treatment in the subset of patients with normal serum ALT and low HBV DNA at baseline, though overall treatment rate in this group was low (only 2% per annum). Thus, patient demographics permit risk stratification for treatment initiation and could determine to a significant extent the frequency of review required for untreated HBeAg-negative patients. Black ethnicity is associated with a significant reduction in risk of treatment initiation.

Modern PET-guided radiotherapy planning and treatment for malignant lymphoma.

Malignant lymphoma comprises a broad spectrum of diverse entities originating from different types of lymphocytes. In the last century, successive improvements of treatment possibilities have led to an continuous amelioration of patient prognosis from lethal outcome to high rates of disease control and long-term survivors. PET/CT-based imaging plays a key role in stratification of stage and treatment response. Especially for radiotherapy, an essential treatment modality for lymphoma patients, functional imaging and the reevaluation of disease activity after frontline chemotherapy has led to major improvements regarding size of treatment fields and toxicity. International expert groups like the International Lymphoma Radiation Oncology Group (ILROG) develop guidelines for the optimal use of imaging for treatment planning. The shift from uniform large-field treatment volumes to complex individual setups taking into account biological response-assessments based on functional imaging resulted in a further de-escalation of side effects and modernization of lymphoma treatment. This paper aims to summarize the use of FDG-PET-imaging for radiation therapy planning in malignant lymphoma in the context of historic and future developments, as well as associated limitations and challenges ahead. We will discuss the contemporary standard of care as recommended by international expert guidelines like the ILROG, the national comprehensive cancer network (NCCN), as well as the newly updated German S3-guidelines.

Clinical trials: A plea to cooperative groups, consortia, pharmaceutical companies, and lead investigators for reasonable imaging protocols.

Clinical trials: A plea to cooperative groups, consortia, pharmaceutical companies, and lead investigators for reasonable imaging protocols.

Cardiovascular Manifestations of the Long COVID Syndrome.

While most coronavirus 2019 (COVID-19) survivors have had complete resolution of symptoms, a significant proportion have suffered from incomplete recovery. Cardiopulmonary symptoms, such as dyspnea, chest pain, and palpitations are responsible for a substantial symptom burden in COVID-19 survivors. Studies have revealed persistent myocardial injury with late gadolinium enhancement and myocardial scar on cardiac magnetic resonance in a significant proportion of patients. Evidence of myocardial edema, active inflammation, left ventricular dysfunction, and right ventricular dysfunction, is limited to a minority of patients. Large observational studies of COVID-19 survivors have indicated an increased risk of cardiovascular disease compared to the general population, including the risk of coronary artery disease, cardiomyopathy, and arrhythmias. Management of long COVID is focused on supportive therapy to reduce systemic inflammation. Patients with high cardiovascular risk, namely, those who had cardiovascular complications during acute illness, patients who have new onset cardiopulmonary symptoms in the postinfectious period, and competitive athletes, should be evaluated by a cardiovascular specialist. Management of cardiovascular sequelae is currently based on general expert guideline recommendations given the lack of evidence specific to long COVID syndrome. In this review, we outline the cardiovascular manifestations of long COVID, the current evidence supporting cardiac abnormalities in the postinfectious period, and the recommended management of these patients.

Periprocedural Anticoagulation.

Management of patients taking anticoagulants around the time of a procedure is a common and complex clinical scenario. Providing evidence-based care requires estimation of risk for thrombosis and bleeding, knowledge of commonly used medications, multidisciplinary communication and collaboration, and patient engagement and education. This review provides a standardized, evidence-based approach to periprocedural management of anticoagulation, based on current evidence and expert clinical guidelines.

MP01-18 DECLINE IN SPERM FREEZE-THAW RECOVERY RATE WITH DELAYED CRYOPRESERVATION

You have accessJournal of UrologyCME1 Apr 2023MP01-18 DECLINE IN SPERM FREEZE-THAW RECOVERY RATE WITH DELAYED CRYOPRESERVATION Andre Belarmino, Daniel Colin, Stacey Kenfield, Stanton Honig, James Dupree, Mary Samplaski, Dolores Lamb, Jerrine Morris, and James Smith Andre BelarminoAndre Belarmino More articles by this author , Daniel ColinDaniel Colin More articles by this author , Stacey KenfieldStacey Kenfield More articles by this author , Stanton HonigStanton Honig More articles by this author , James DupreeJames Dupree More articles by this author , Mary SamplaskiMary Samplaski More articles by this author , Dolores LambDolores Lamb More articles by this author , Jerrine MorrisJerrine Morris More articles by this author , and James SmithJames Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003212.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sperm cryopreservation requires in-person visits to produce an ejaculate and immediately freeze the sample. Recently, companies began offering services for mail-in semen analysis (SA) testing and cryopreservation. However, the effects of delayed cryopreservation associated with shipping times were generally understudied. Our laboratory has continued to optimize our cryopreservation technique. This study aims to define the effect of delayed cryopreservation on the recovered total motile count (TMC) compared to standard immediate cryopreservation, using our improved methods. METHODS: Fresh semen samples were provided from healthy volunteers. Samples were diluted with 5 mL of a proprietary preservation solution, mixed, and allowed to liquify for 30 minutes. Samples were then analyzed per World Health Organization (WHO) guidelines V5 and those with abnormal concentration, volume, or motility were excluded. Samples were then divided into 3 aliquots. Aliquot #1, T0 was immediately frozen with equal part cryoprotectant. Aliquot #2, T24 was left at room temperature for 24hrs, analyzed on the SQA (sperm quality analyzer) and then frozen with cryoprotectant. Aliquot #3, T48 was left at room temperature for 48hrs, analyzed on the SQA, and then frozen with cryoprotectant. 24hrs after the third aliquot was frozen, all aliquots were thawed in an incubator at 37C for 10 minutes and analyzed on the SQA. RESULTS: Eight adult men provided a total of 26 semen samples. Baseline SA values were: volume 3.4 ml±1.2, concentration 128.2±48.7 × 106, motility 49%±7%; TMC 211±109 million. A decline in % motility was observed after specimens sat at room temperature, as well as after freeze-thaw in most individuals. The average loss from freeze/thaw in TMC at T0 was 44.0%, at T24 was 47% relative to T24 pre-freeze, and at T48 was 65% relative to T48 pre-freeze (p=0.046) (Figure 1). CONCLUSIONS: This analysis reveals a superior freeze-thaw protocol compared to our prior methods, as we continue to refine our process, and follow best practice guidelines of experts in the field. Further investigation is needed to improve the methods needed for shipping with the goal of improving the freeze-thaw recovery rate with delayed cryopreservation. Source of Funding: Fellow Health Inc. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e9 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andre Belarmino More articles by this author Daniel Colin More articles by this author Stacey Kenfield More articles by this author Stanton Honig More articles by this author James Dupree More articles by this author Mary Samplaski More articles by this author Dolores Lamb More articles by this author Jerrine Morris More articles by this author James Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Quality indicators in the endoscopic detection of gastric cancer

Gastroscopy is the reference standard for the diagnosis of gastric cancer, but it is operator-dependent and associated with missed gastric cancer. The proliferation of gastroscopic examinations, increasingly for the screening and detection of subtle premalignant lesions, has motivated scrutiny of quality in gastroscopy. The concept of a high-quality endoscopic examination for the detection of superficial gastric neoplasia has been defined by expert guidelines to improve mucosal visualization, engender a systematic examination process and detect superficial neoplasia. This review discusses the evidence supporting the components of a high-quality diagnostic gastroscopic examination in relation to the detection of gastric cancer, and their potential role as procedural quality indicators to drive a structured improvement in clinically meaningful outcomes.

IT-based regulation of personal health: Nudging, mobile apps and data

Mobile health applications and devices (“mobile health apps”) play increasingly important roles in the lives of individuals interested in self-regulating their personal health behaviors. While some appear to be simply consumer products and services, many are embedded in regulatory programs aimed at compliance with expert guidelines. In this paper, we draw on de Vaujany et al.’s framework for organizational IT-based regulation systems to consider how systems operate in open and distributed contexts in which actors have strong agency and regulation is indirect and voluntary. To do so, we consider how IT artifacts become embedded in practices, how data are implicated in regulatory feedback loops, and how individual, organizational and technological actors are mobilized and with what regulatory outcomes. We develop an instrumental case study as a vignette of five regulatory episodes (continuous glucose monitoring systems used by persons with diabetes) to examine how expert rules materialized in mobile health apps, data about bodily states, and IT features such as displays and alarms “nudge” individuals towards compliance with self-regulatory guidelines and practices. Through this analysis, we identify two related regulatory affordances of mobile health apps for predicting and surveilling personal health. We theorize how multilevel networks composed of trifecta of rules, IT artifacts, and practices develop as a regulatory lattice through which social regulation is realized. We conclude by considering the broader implications of this analytical approach to study voluntary, data-enriched regulatory systems.

Replacing Endoscopy with Magnetic Resonance Enterography for Mucosal Activity Assessment in Terminal Ileal Crohn's Disease: Are We There Yet?

Crohn's disease (CD) is a chronic immune mediated disorder that most commonly affects the small bowel and/or the large bowel. Treatment targets in CD include mucosal healing assessed via ileocolonoscopy and transmural healing assessed through cross-sectional imaging modalities such as magnetic resonance enterography (MRE). More recently, histological healing in CD has emerged as a treatment target, though it is made cumbersome given its reliance on frequent endoscopic examinations. With expert guidelines now recommending regular objective assessments as part of a treat-to-target approach, accurate non-invasive assessment will become increasingly critical. MRE has an established role in the assessment of small bowel CD, with growing data supportive of its ability in detecting disease activity at mucosal and histological levels. This could therefore potentially reduce the need for serial endoscopic assessment. Thus, this review will assess the capacity of individual MRE parameters and MRE indices for detecting mucosal and histological small bowel CD activity. Furthermore, challenging scenarios, such as CD activity detection in post-operative clinical scenarios and abnormal findings in the context of a normal ileocolonoscopy, will be explored.

A retrospective study to identify the compliance with SDCEP guidelines of exodontia patients taking oral anticoagulant and antiplatelet medication

AbstractIntroductionExodontia treatment plans for oral anticoagulant and antiplatelet patients should consider Scottish Dental Clinical Effectiveness Programme (SDCEP) management guidelines. No previous literature has identified SDCEP guidelines compliance. The aim of this study was to determine how Oral Surgery staff manage exodontia patients who take antithrombotic medication, and the extent to which management principles consider SDCEP guidelines.Materials and MethodsAll clinical records were retrospectively analysed to identify patients who matched our criteria and had an exodontia procedure undertaken at Birmingham Dental Hospital over a 3‐month period.ResultsInitial records (n = 2961) of exodontia patients identified that 7.8% (n = 231) of patients were taking oral antithrombotic medication; 163 patients on Antiplatelet medication, 42 on Novel Oral Anticoagulants (NOAC) and 24 on Warfarin. No Antiplatelet or Warfarin patient had their medication regime interrupted. All Warfarin patients had their INR performed and recorded within 72 h of the procedure. A notable difference was found between managing high and low‐risk bleeding procedures for NOAC patients, although this was not statistically significant. Local intra‐operative haemostatic measures applied were significantly different between each of the drug groups (p < 0.001). No local haemostatic measures were recorded in 45% of Antiplatelet patients, compared to 4.8% of NOAC and 12.5% of Warfarin cases. Self‐referrals are presented more commonly on a Thursday or Friday (p = 0.037).ConclusionsEach treatment plan should be considered on an individual basis, combining clinician expertise and clinical guidelines to optimise patient care. Areas of poor compliance were identified with further research being required to comprehend how compliance with the literature alters post‐operative haemostatic complications.

Redefinition of dementia care in Italy in the era of amyloid-lowering agents for the treatment of Alzheimer’s disease: an expert opinion and practical guideline

No disease-modifying therapies are currently available for Alzheimer’s disease (AD) in Europe. Current evidence from clinical trials testing anti-beta amyloid (Aβ) monoclonal antibodies (mAbs) in patients with early AD, though, suggests a likely marketing authorization in the next years. Since the implementation of disease-modifying therapies for AD in the clinical practice will evidently require a huge change of dementia care in all countries, a group of prominent AD clinical experts in Italy met to discuss patients’ selection and management strategies. The current diagnostic–therapeutic standard of care in Italy was taken as the starting point. The prescription of new therapies cannot ignore the definition of a biological diagnosis through the assessment of both amyloid- and tau-related biomarkers. The high risk/benefit ratio of anti-Aβ immunotherapies, moreover, needs a highly specialized diagnostic work-up and a thorough exclusion criteria assessment, which should be provided by a neurology specialist. The Expert Panel also suggests a reorganization of the Centers for dementia and cognitive decline in Italy into 3 levels of increasing complexity: community center, first- and second-level center. Tasks and requirements for each level were defined. Finally, specific characteristics of a center deputed to prescribe anti-Aβ mAbs were discussed.

Expert guidelines on exercise and physical activity for people with cystic fibrosis

Research has shown that there is a lack of confidence and understanding in how to use exercise for managing cystic fibrosis. This editorial discusses the key points of a consensus statement that highlights what is and is not known about the relationship between cystic fibrosis and exercise.

2022 Chinese expert consensus and guidelines on clinical management of toxicity in anti-CD19 chimeric antigen receptor T-cell therapy for B-cell non-Hodgkin lymphoma.

Adoptive cellular immunotherapy with chimeric antigen receptor (CAR) T cells has emerged as a novel modality for treating relapsed and/or refractory B-cell non-Hodgkin lymphoma (B-NHL). With increasing approval of CAR T-cell products and advances in CAR T cell therapy, CAR T cells are expected to be used in a growing number of cases. However, CAR T-cell-associated toxicities can be severe or even fatal, thus compromising the survival benefit from this therapy. Standardizing and studying the clinical management of these toxicities are imperative. In contrast to other hematological malignancies, such as acute lymphoblastic leukemia and multiple myeloma, anti-CD19 CAR T-cell-associated toxicities in B-NHL have several distinctive features, most notably local cytokine-release syndrome (CRS). However, previously published guidelines have provided few specific recommendations for the grading and management of toxicities associated with CAR T-cell treatment for B-NHL. Consequently, we developed this consensus for the prevention, recognition, and management of these toxicities, on the basis of published literature regarding the management of anti-CD19 CAR T-cell-associated toxicities and the clinical experience of multiple Chinese institutions. This consensus refines a grading system and classification of CRS in B-NHL and corresponding measures for CRS management, and delineates comprehensive principles and exploratory recommendations for managing anti-CD19 CAR T-cell-associated toxicities in addition to CRS.

“National survey for preliminary evaluation of neuroradiological protocols in patients with infective endocarditis”

ObjectivesThe aim of this study was to identify imaging protocols in patients with infective endocarditis through a nationwide survey. MethodsAn electronic evolutionary survey was sent to interventional Neuroradiologists among neuroradiological centers, under the aegis of the Société Française de Neuroradiologie. Among 33 contacted centers, 25 completed the survey (21 universitary hospitals and 4 peripheric hospitals). ResultsMost of the centers (88%) used systematic imaging screening in IE patients. MRI was the first imaging method used in 56% of cases, while CT was used in 44%. When no IIA was detectable in CT-scan screening, 6 (54%) stopped investigations, while 9 (81%) continued with MRI exploration in case of hemorrhage, ischemia or enhancement. Sulcal hemorrhage on MRI was an indication of complementary DSA in 25 centers (100%). Regarding IIA characterization, 12 centers (48%) used systematic DSA, whereas for 10 centers (40%), DSA was conditioned by hemorrhage or patient status. ConclusionWe highlighted large variations in Neuroimaging exploration and follow-up of IE patients in real-world practices. Expert guidelines able to standardize practices are warranted to improve the management of this serious and often misdiagnosed pathology.